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 $338.84 / $457.09 / $851.14	Professional		$338.84	$457.09	$851.14
Cigna Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $575.44 / $575.44	Facility		$575.44	$575.44	$575.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $416.87 / $575.44	Professional		$416.87	$416.87	$575.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $1,174.90 / $2,884.03	Facility		$478.63	$1,174.90	$2,884.03
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $1,148.15 / $1,862.09	Professional		$478.63	$1,148.15	$1,862.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $776.25 / $851.14	Professional		$75.86	$776.25	$851.14
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $977.24 / $1,023.29	Facility		$794.33	$977.24	$1,023.29
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,000.00 / $1,023.29	Professional		$912.01	$1,000.00	$1,023.29
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $1,479.11 / $2,137.96	Facility		$870.96	$1,479.11	$2,137.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $831.76 / $1,096.48	Professional		$831.76	$831.76	$1,096.48
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $977.24 / $977.24 / $977.24	Facility		$977.24	$977.24	$977.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $870.96 / $1,122.02	Professional		$831.76	$870.96	$1,122.02
United Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,258.93 / $1,258.93	Facility		$467.74	$1,258.93	$1,258.93
United Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $512.86 / $724.44	Professional		$363.08	$512.86	$724.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $870.96 / $1,548.82	Professional		$724.44	$870.96	$1,548.82