Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $954.99 / $954.99 / $2,238.72	Facility		$954.99	$954.99	$2,238.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $891.25 / $1,621.81	Professional		$660.69	$891.25	$1,621.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $912.01 / $912.01	Facility		$912.01	$912.01	$912.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $660.69 / $912.01	Professional		$660.69	$660.69	$912.01
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $912.01 / $2,187.76 / $4,168.69	Facility		$912.01	$2,187.76	$4,168.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,862.09 / $3,388.44	Professional		$912.01	$1,862.09	$3,388.44
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 / $1,584.89	Facility		$1,148.15	$1,412.54	$1,584.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,445.44 / $1,584.89	Professional		$1,318.26	$1,445.44	$1,584.89
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 / $1,584.89	Professional		$1,202.26	$1,202.26	$1,584.89
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 $812.83 / $2,398.83 / $2,398.83	Facility		$812.83	$2,398.83	$2,398.83
United Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $977.24 / $1,380.38	Professional		$691.83	$977.24	$1,380.38
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