Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $562.34 / $562.34 / $1,318.26	Facility		$562.34	$562.34	$1,318.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $467.74 / $776.25	Professional		$380.19	$467.74	$776.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $630.96 / $630.96	Facility		$630.96	$630.96	$630.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $457.09 / $630.96	Professional		$457.09	$457.09	$630.96
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $489.78 / $1,230.27 / $2,454.71	Facility		$489.78	$1,230.27	$2,454.71
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $1,096.48 / $1,819.70	Professional		$489.78	$1,096.48	$1,819.70
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $660.69 / $724.44	Professional		$75.86	$660.69	$724.44
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $831.76 / $891.25	Facility		$676.08	$831.76	$891.25
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $851.14 / $891.25	Professional		$776.25	$851.14	$891.25
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $1,258.93 / $1,819.70	Facility		$758.58	$1,258.93	$1,819.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $707.95 / $933.25	Professional		$707.95	$707.95	$933.25
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $831.76 / $831.76 / $831.76	Facility		$831.76	$831.76	$831.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $741.31 / $954.99	Professional		$707.95	$741.31	$954.99
United Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $1,288.25 / $1,288.25	Facility		$512.86	$1,288.25	$1,288.25
United Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $524.81 / $741.31	Professional		$371.54	$524.81	$741.31
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $616.60 / $1,318.26	Professional		$478.63	$616.60	$1,318.26