Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $691.83 / $691.83 / $1,659.59	Facility		$691.83	$691.83	$1,659.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $562.34 / $1,096.48	Professional		$416.87	$562.34	$1,096.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $588.84 / $588.84	Facility		$588.84	$588.84	$588.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $426.58 / $588.84	Professional		$426.58	$426.58	$588.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $1,380.38 / $3,090.30	Facility		$588.84	$1,380.38	$3,090.30
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $1,258.93 / $2,137.96	Professional		$588.84	$1,258.93	$2,137.96
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $831.76 / $912.01	Professional		$75.86	$831.76	$912.01
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $977.24 / $1,071.52	Facility		$851.14	$977.24	$1,071.52
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,071.52 / $1,071.52	Professional		$977.24	$1,071.52	$1,071.52
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $1,584.89 / $2,290.87	Facility		$933.25	$1,584.89	$2,290.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $891.25 / $1,174.90	Professional		$891.25	$891.25	$1,174.90
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,047.13 / $1,047.13 / $1,047.13	Facility		$1,047.13	$1,047.13	$1,047.13
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $933.25 / $1,202.26	Professional		$891.25	$933.25	$1,202.26
United Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $1,513.56 / $1,513.56	Facility		$467.74	$1,513.56	$1,513.56
United Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $630.96 / $891.25	Professional		$436.52	$630.96	$891.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $933.25 / $1,659.59	Professional		$776.25	$933.25	$1,659.59