Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $851.14 / $2,041.74	Facility		$851.14	$851.14	$2,041.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $691.83 / $1,096.48	Professional		$537.03	$691.83	$1,096.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $724.44 / $724.44	Facility		$724.44	$724.44	$724.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $724.44	Professional		$524.81	$524.81	$724.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,148.15 / $2,187.76 / $3,801.89	Facility		$1,148.15	$2,187.76	$3,801.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,862.09 / $2,951.21	Professional		$1,122.02	$1,862.09	$2,951.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $977.24 / $1,071.52	Professional		$75.86	$977.24	$1,071.52
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,258.93 / $1,318.26	Facility		$1,230.27	$1,258.93	$1,318.26
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Professional		$1,000.00	$1,000.00	$1,000.00
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,862.09 / $2,691.53	Facility		$1,096.48	$1,862.09	$2,691.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $1,380.38	Professional		$1,047.13	$1,047.13	$1,380.38
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,096.48 / $1,412.54	Professional		$1,047.13	$1,096.48	$1,412.54
United Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $1,905.46 / $1,905.46	Facility		$575.44	$1,905.46	$1,905.46
United Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $616.60 / $1,096.48	Professional		$549.54	$616.60	$1,096.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $912.01 / $1,949.84	Professional		$758.58	$912.01	$1,949.84