Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $302.00 / $724.44	Facility		$302.00	$302.00	$724.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $239.88 / $416.87	Professional		$169.82	$239.88	$416.87
Cigna Facility/Professional Facility Modifier Low / Median / High Price $309.03 / $309.03 / $309.03	Facility		$309.03	$309.03	$309.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $223.87 / $309.03	Professional		$223.87	$223.87	$309.03
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $251.19 / $588.84 / $1,318.26	Facility		$251.19	$588.84	$1,318.26
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $549.54 / $933.25	Professional		$251.19	$549.54	$933.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $354.81 / $389.05	Professional		$75.86	$354.81	$389.05
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $398.11 / $467.74	Facility		$371.54	$398.11	$467.74
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $467.74 / $467.74	Professional		$398.11	$467.74	$467.74
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $407.38 / $676.08 / $1,000.00	Facility		$407.38	$676.08	$1,000.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $389.05 / $512.86	Professional		$389.05	$389.05	$512.86
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $457.09 / $457.09	Facility		$457.09	$457.09	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $407.38 / $524.81	Professional		$380.19	$407.38	$524.81
United Facility/Professional Facility Modifier Low / Median / High Price $245.47 / $645.65 / $645.65	Facility		$245.47	$645.65	$645.65
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $263.03 / $380.19	Professional		$186.21	$263.03	$380.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $407.38 / $707.95	Professional		$331.13	$407.38	$707.95