Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $12,882.50 / $27,542.29	Facility		$1,778.28	$12,882.50	$27,542.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $812.83 / $2,511.89	Professional		$457.09	$812.83	$2,511.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Professional		$1,621.81	$1,621.81	$1,621.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $707.95 / $954.99	Facility		$501.19	$707.95	$954.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $1,348.96 / $3,388.44	Professional		$1,122.02	$1,348.96	$3,388.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $5,370.32 / $23,442.29	Facility		$3,801.89	$5,370.32	$23,442.29
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $3,311.31 / $5,128.61 / $7,413.10	Professional		$3,311.31	$5,128.61	$7,413.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $812.83	Professional		$32.36	$33.11	$812.83
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $575.44 / $812.83 / $3,090.30	Facility		$575.44	$812.83	$3,090.30
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $1,122.02 / $1,202.26	Facility		$1,122.02	$1,122.02	$1,202.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,698.24 / $2,570.40	Professional		$1,148.15	$1,698.24	$2,570.40
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $10,715.19 / $16,218.10 / $30,902.95	Facility		$10,715.19	$16,218.10	$30,902.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,412.54 / $2,187.76	Professional		$1,096.48	$1,412.54	$2,187.76
United Facility/Professional Facility Modifier Low / Median / High Price $2,137.96 / $17,378.01 / $33,884.42	Facility		$2,137.96	$17,378.01	$33,884.42
United Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $724.44 / $1,698.24	Professional		$295.12	$724.44	$1,698.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $933.25 / $1,548.82	Professional		$812.83	$933.25	$1,548.82