Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $933.25 / $1,174.90	Facility		$489.78	$933.25	$1,174.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $446.68 / $676.08	Professional		$323.59	$446.68	$676.08
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 $354.81 / $354.81 / $489.78	Professional		$354.81	$354.81	$489.78
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,122.02 / $2,137.96	Facility		$467.74	$1,122.02	$2,137.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $977.24 / $1,737.80	Professional		$467.74	$977.24	$1,737.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $575.44 / $645.65	Professional		$75.86	$575.44	$645.65
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $741.31 / $758.58	Facility		$602.56	$741.31	$758.58
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $758.58 / $758.58	Professional		$676.08	$758.58	$758.58
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $1,122.02 / $1,621.81	Facility		$660.69	$1,122.02	$1,621.81
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $630.96 / $870.96	Professional		$630.96	$630.96	$870.96
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $741.31 / $741.31 / $741.31	Facility		$741.31	$741.31	$741.31
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $660.69 / $851.14	Professional		$630.96	$660.69	$851.14
United Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,230.27 / $1,230.27	Facility		$489.78	$1,230.27	$1,230.27
United Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $501.19 / $707.95	Professional		$354.81	$501.19	$707.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $660.69 / $1,148.15	Professional		$537.03	$660.69	$1,148.15