Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $660.69 / $1,584.89	Facility		$660.69	$660.69	$1,584.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $616.60 / $1,023.29	Professional		$436.52	$616.60	$1,023.29
Cigna Facility/Professional Facility Modifier Low / Median / High Price $660.69 / $660.69 / $660.69	Facility		$660.69	$660.69	$660.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $478.63 / $660.69	Professional		$478.63	$478.63	$660.69
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $1,513.56 / $2,951.21	Facility		$645.65	$1,513.56	$2,951.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $1,288.25 / $2,344.23	Professional		$645.65	$1,288.25	$2,344.23
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 $812.83 / $1,000.00 / $1,348.96	Facility		$812.83	$1,000.00	$1,348.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,023.29 / $1,348.96	Professional		$912.01	$1,023.29	$1,348.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $891.25 / $1,479.11 / $2,187.76	Facility		$891.25	$1,479.11	$2,187.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $851.14 / $1,174.90	Professional		$851.14	$851.14	$1,174.90
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,000.00 / $1,000.00 / $1,000.00	Facility		$1,000.00	$1,000.00	$1,000.00
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $891.25 / $1,148.15	Professional		$891.25	$891.25	$1,148.15
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $1,659.59 / $1,659.59	Facility		$676.08	$1,659.59	$1,659.59
United Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $676.08 / $977.24	Professional		$478.63	$676.08	$977.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $891.25 / $1,548.82	Professional		$724.44	$891.25	$1,548.82