Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $1,548.82	Facility		$645.65	$645.65	$1,548.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $537.03 / $891.25	Professional		$416.87	$537.03	$891.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $549.54 / $549.54	Facility		$549.54	$549.54	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $398.11 / $549.54	Professional		$398.11	$398.11	$549.54
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $549.54 / $1,380.38 / $2,754.23	Facility		$549.54	$1,380.38	$2,754.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $1,230.27 / $2,041.74	Professional		$549.54	$1,230.27	$2,041.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $741.31 / $812.83	Professional		$75.86	$741.31	$812.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $933.25 / $1,000.00	Facility		$758.58	$933.25	$1,000.00
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $954.99 / $1,000.00	Professional		$870.96	$954.99	$1,000.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $1,412.54 / $2,089.30	Facility		$851.14	$1,412.54	$2,089.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $794.33 / $1,047.13	Professional		$794.33	$794.33	$1,047.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $933.25 / $933.25	Facility		$933.25	$933.25	$933.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $831.76 / $1,071.52	Professional		$794.33	$831.76	$1,071.52
United Facility/Professional Facility Modifier Low / Median / High Price $436.52 / $1,445.44 / $1,445.44	Facility		$436.52	$1,445.44	$1,445.44
United Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $478.63 / $831.76	Professional		$407.38	$478.63	$831.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $691.83 / $1,479.11	Professional		$501.19	$691.83	$1,479.11