Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $398.11 / $398.11 / $933.25	Facility		$398.11	$398.11	$933.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $338.84 / $549.54	Professional		$269.15	$338.84	$549.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $407.38 / $407.38 / $407.38	Facility		$407.38	$407.38	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $407.38	Professional		$295.12	$295.12	$407.38
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $354.81 / $831.76 / $1,737.80	Facility		$354.81	$831.76	$1,737.80
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $724.44 / $1,288.25	Professional		$354.81	$724.44	$1,288.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $467.74 / $512.86	Professional		$75.86	$467.74	$512.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $602.56 / $630.96	Facility		$489.78	$602.56	$630.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $549.54 / $616.60 / $630.96	Professional		$549.54	$616.60	$630.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $537.03 / $891.25 / $1,318.26	Facility		$537.03	$891.25	$1,318.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $676.08	Professional		$512.86	$512.86	$676.08
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $602.56 / $602.56	Facility		$602.56	$602.56	$602.56
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $524.81 / $691.83	Professional		$501.19	$524.81	$691.83
United Facility/Professional Facility Modifier Low / Median / High Price $371.54 / $912.01 / $912.01	Facility		$371.54	$912.01	$912.01
United Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $371.54 / $537.03	Professional		$263.03	$371.54	$537.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $436.52 / $933.25	Professional		$338.84	$436.52	$933.25