Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $389.05 / $912.01	Facility		$389.05	$389.05	$912.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $501.19	Professional		$194.98	$269.15	$501.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $338.84 / $338.84	Facility		$338.84	$338.84	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $338.84	Professional		$245.47	$245.47	$338.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $281.84 / $691.83 / $1,698.24	Facility		$281.84	$691.83	$1,698.24
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $660.69 / $1,096.48	Professional		$281.84	$660.69	$1,096.48
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $457.09 / $501.19	Professional		$75.86	$457.09	$501.19
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $446.68 / $467.74 / $588.84	Facility		$446.68	$467.74	$588.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $562.34 / $588.84	Professional		$457.09	$562.34	$588.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $524.81 / $870.96 / $1,288.25	Facility		$524.81	$870.96	$1,288.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $489.78 / $645.65	Professional		$489.78	$489.78	$645.65
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $575.44 / $575.44	Facility		$575.44	$575.44	$575.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $512.86 / $660.69	Professional		$489.78	$512.86	$660.69
United Facility/Professional Facility Modifier Low / Median / High Price $295.12 / $724.44 / $724.44	Facility		$295.12	$724.44	$724.44
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $426.58	Professional		$208.93	$295.12	$426.58
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $512.86 / $912.01	Professional		$426.58	$512.86	$912.01