Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,258.93	Facility		$1,258.93	$1,258.93	$1,258.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,230.27 / $1,288.25	Professional		$1,202.26	$1,230.27	$1,288.25
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $2,511.89	Facility		$1,258.93	$1,258.93	$2,511.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,258.93	Professional		$1,258.93	$1,258.93	$1,258.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $0.52 / $0.52 / $0.52	Professional		$0.52	$0.52	$0.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $50.12 / $75.86	Professional		$30.20	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Facility		$288.40	$288.40	$288.40
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,258.93	Facility		$1,230.27	$1,230.27	$1,258.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,258.93	Professional		$1,258.93	$1,258.93	$1,258.93
United Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,258.93	Professional		$1,258.93	$1,258.93	$1,258.93