Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $776.25 / $1,862.09	Facility		$776.25	$776.25	$1,862.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $602.56 / $1,288.25	Professional		$478.63	$602.56	$1,288.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $616.60 / $616.60 / $616.60	Facility		$616.60	$616.60	$616.60
Cigna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $616.60	Professional		$457.09	$457.09	$616.60
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $1,479.11 / $3,311.31	Facility		$630.96	$1,479.11	$3,311.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $1,348.96 / $2,344.23	Professional		$630.96	$1,348.96	$2,344.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $794.33 / $977.24	Professional		$75.86	$794.33	$977.24
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $1,000.00 / $1,148.15	Facility		$912.01	$1,000.00	$1,148.15
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,148.15 / $1,148.15	Professional		$1,000.00	$1,148.15	$1,148.15
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,023.29 / $1,698.24 / $2,511.89	Facility		$1,023.29	$1,698.24	$2,511.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $954.99 / $1,318.26	Professional		$954.99	$954.99	$1,318.26
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,122.02	Facility		$1,122.02	$1,122.02	$1,122.02
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $954.99 / $1,000.00 / $1,288.25	Professional		$954.99	$1,000.00	$1,288.25
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,621.81 / $1,621.81	Facility		$489.78	$1,621.81	$1,621.81
United Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $575.44 / $954.99	Professional		$457.09	$575.44	$954.99
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $602.56 / $831.76 / $1,778.28	Professional		$602.56	$831.76	$1,778.28