Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $478.63 / $478.63 / $1,148.15	Facility		$478.63	$478.63	$1,148.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $398.11 / $676.08	Professional		$302.00	$398.11	$676.08
Cigna Facility/Professional Facility Modifier Low / Median / High Price $416.87 / $416.87 / $416.87	Facility		$416.87	$416.87	$416.87
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $309.03 / $416.87	Professional		$309.03	$309.03	$416.87
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $426.58 / $1,000.00 / $2,137.96	Facility		$426.58	$1,000.00	$2,137.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $870.96 / $1,548.82	Professional		$426.58	$870.96	$1,548.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $575.44 / $630.96	Professional		$75.86	$575.44	$630.96
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $588.84 / $691.83 / $741.31	Facility		$588.84	$691.83	$741.31
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $741.31 / $741.31	Professional		$676.08	$741.31	$741.31
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $645.65 / $1,096.48 / $1,584.89	Facility		$645.65	$1,096.48	$1,584.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $616.60 / $812.83	Professional		$616.60	$616.60	$812.83
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $724.44 / $724.44	Facility		$724.44	$724.44	$724.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $616.60 / $645.65 / $831.76	Professional		$616.60	$645.65	$831.76
United Facility/Professional Facility Modifier Low / Median / High Price $338.84 / $1,096.48 / $1,096.48	Facility		$338.84	$1,096.48	$1,096.48
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $446.68 / $630.96	Professional		$316.23	$446.68	$630.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $537.03 / $1,148.15	Professional		$446.68	$537.03	$1,148.15