Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $870.96 / $2,089.30	Facility		$870.96	$870.96	$2,089.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $676.08 / $1,148.15	Professional		$478.63	$676.08	$1,148.15
Cigna Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $707.95 / $707.95	Facility		$707.95	$707.95	$707.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $707.95	Professional		$512.86	$512.86	$707.95
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $707.95 / $1,659.59 / $3,890.45	Facility		$707.95	$1,659.59	$3,890.45
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,584.89 / $2,691.53	Professional		$707.95	$1,584.89	$2,691.53
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,047.13 / $1,148.15	Professional		$75.86	$1,047.13	$1,148.15
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $1,258.93 / $1,348.96	Facility		$1,071.52	$1,258.93	$1,348.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,348.96 / $1,348.96	Professional		$1,230.27	$1,348.96	$1,348.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $1,995.26 / $2,884.03	Facility		$1,174.90	$1,995.26	$2,884.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,479.11	Professional		$1,122.02	$1,122.02	$1,479.11
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,318.26	Facility		$1,318.26	$1,318.26	$1,318.26
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,174.90 / $1,513.56	Professional		$1,122.02	$1,174.90	$1,513.56
United Facility/Professional Facility Modifier Low / Median / High Price $741.31 / $1,819.70 / $1,819.70	Facility		$741.31	$1,819.70	$1,819.70
United Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $758.58 / $1,071.52	Professional		$524.81	$758.58	$1,071.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,174.90 / $2,089.30	Professional		$977.24	$1,174.90	$2,089.30