Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $977.24 / $977.24 / $2,344.23	Facility		$977.24	$977.24	$2,344.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $870.96 / $1,584.89	Professional		$676.08	$870.96	$1,584.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $891.25 / $891.25	Facility		$891.25	$891.25	$891.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $891.25	Professional		$645.65	$645.65	$891.25
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $2,041.74 / $4,168.69	Facility		$870.96	$2,041.74	$4,168.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,778.28 / $3,162.28	Professional		$870.96	$1,778.28	$3,162.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,122.02 / $1,230.27	Professional		$75.86	$1,122.02	$1,230.27
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,148.15 / $1,412.54 / $1,548.82	Facility		$1,148.15	$1,412.54	$1,548.82
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,445.44 / $1,548.82	Professional		$1,318.26	$1,445.44	$1,548.82
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $2,137.96 / $3,162.28	Facility		$1,288.25	$2,137.96	$3,162.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,698.24	Professional		$1,202.26	$1,202.26	$1,698.24
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,412.54 / $1,412.54 / $1,412.54	Facility		$1,412.54	$1,412.54	$1,412.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,258.93 / $1,621.81	Professional		$1,202.26	$1,258.93	$1,621.81
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $2,238.72 / $2,238.72	Facility		$676.08	$2,238.72	$2,238.72
United Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $794.33 / $1,318.26	Professional		$645.65	$794.33	$1,318.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,258.93 / $2,238.72	Professional		$1,047.13	$1,258.93	$2,238.72