Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $2,511.89	Facility		$1,071.52	$1,071.52	$2,511.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $831.76 / $1,445.44	Professional		$630.96	$831.76	$1,445.44
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility		$1,096.48	$1,096.48	$1,096.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,096.48	Professional		$812.83	$812.83	$1,096.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $2,041.74 / $4,677.35	Facility		$870.96	$2,041.74	$4,677.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,905.46 / $3,311.31	Professional		$870.96	$1,905.46	$3,311.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,258.93 / $1,380.38	Professional		$75.86	$1,258.93	$1,380.38
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,412.54 / $1,659.59	Facility		$1,288.25	$1,412.54	$1,659.59
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,659.59 / $1,659.59	Professional		$1,412.54	$1,659.59	$1,659.59
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $2,398.83 / $3,548.13	Facility		$1,445.44	$2,398.83	$3,548.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,778.28	Professional		$1,348.96	$1,348.96	$1,778.28
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Facility		$1,584.89	$1,584.89	$1,584.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,412.54 / $1,862.09	Professional		$1,348.96	$1,412.54	$1,862.09
United Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $2,238.72 / $2,238.72	Facility		$776.25	$2,238.72	$2,238.72
United Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $912.01 / $1,318.26	Professional		$645.65	$912.01	$1,318.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,412.54 / $2,511.89	Professional		$1,174.90	$1,412.54	$2,511.89