Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $426.58 / $1,000.00	Facility		$426.58	$426.58	$1,000.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $346.74 / $645.65	Professional		$245.47	$346.74	$645.65
Cigna Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $489.78 / $489.78	Facility		$489.78	$489.78	$489.78
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $489.78	Professional		$363.08	$363.08	$489.78
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $363.08 / $851.14 / $1,862.09	Facility		$363.08	$851.14	$1,862.09
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $776.25 / $1,318.26	Professional		$363.08	$776.25	$1,318.26
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $501.19 / $549.54	Professional		$75.86	$501.19	$549.54
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $524.81 / $575.44 / $660.69	Facility		$524.81	$575.44	$660.69
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $660.69 / $660.69	Professional		$575.44	$660.69	$660.69
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $954.99 / $1,412.54	Facility		$575.44	$954.99	$1,412.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $549.54 / $724.44	Professional		$549.54	$549.54	$724.44
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Facility		$645.65	$645.65	$645.65
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $575.44 / $741.31	Professional		$537.03	$575.44	$741.31
United Facility/Professional Facility Modifier Low / Median / High Price $331.13 / $933.25 / $933.25	Facility		$331.13	$933.25	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $380.19 / $549.54	Professional		$269.15	$380.19	$549.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $575.44 / $1,000.00	Professional		$467.74	$575.44	$1,000.00