Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $891.25 / $2,137.96	Facility		$891.25	$891.25	$2,137.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $794.33 / $1,202.26	Professional		$616.60	$794.33	$1,202.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $831.76 / $831.76	Facility		$831.76	$831.76	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $602.56 / $831.76	Professional		$602.56	$602.56	$831.76
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $1,995.26 / $3,801.89	Facility		$831.76	$1,995.26	$3,801.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,698.24 / $3,090.30	Professional		$831.76	$1,698.24	$3,090.30
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,023.29 / $1,122.02	Professional		$75.86	$1,023.29	$1,122.02
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,288.25 / $1,513.56	Facility		$1,047.13	$1,288.25	$1,513.56
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,318.26 / $1,513.56	Professional		$1,202.26	$1,318.26	$1,513.56
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $1,949.84 / $2,884.03	Facility		$1,174.90	$1,949.84	$2,884.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,548.82	Professional		$1,096.48	$1,096.48	$1,548.82
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $1,288.25	Facility		$1,288.25	$1,288.25	$1,288.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,148.15 / $1,479.11	Professional		$1,096.48	$1,148.15	$1,479.11
United Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $2,187.76 / $2,187.76	Facility		$660.69	$2,187.76	$2,187.76
United Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $724.44 / $1,258.93	Professional		$616.60	$724.44	$1,258.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,148.15 / $2,041.74	Professional		$954.99	$1,148.15	$2,041.74