Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $12,302.69 / $27,542.29	Facility		$2,570.40	$12,302.69	$27,542.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $2,187.76 / $2,691.53	Professional		$457.09	$2,187.76	$2,691.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,884.03 / $6,165.95 / $7,079.46	Facility		$2,884.03	$6,165.95	$7,079.46
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,754.23 / $12,882.50	Facility		$2,454.71	$2,754.23	$12,882.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,754.23 / $4,677.35	Professional		$2,187.76	$2,754.23	$4,677.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $75.86	Professional		$44.67	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $3,019.95 / $4,786.30	Facility		$2,454.71	$3,019.95	$4,786.30
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,754.23 / $4,786.30 / $8,317.64	Facility		$2,754.23	$4,786.30	$8,317.64
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $3,311.31	Professional		$2,454.71	$2,454.71	$3,311.31
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,884.03 / $4,168.69 / $7,244.36	Facility		$2,884.03	$4,168.69	$7,244.36
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,344.23 / $2,454.71 / $3,090.30	Professional		$2,344.23	$2,454.71	$3,090.30
United Facility/Professional Facility Modifier Low / Median / High Price $2,754.23 / $3,311.31 / $3,311.31	Facility		$2,754.23	$3,311.31	$3,311.31
United Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $3,090.30	Professional		$1,148.15	$1,148.15	$3,090.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $2,754.23 / $5,011.87	Professional		$1,230.27	$2,754.23	$5,011.87