Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $9,120.11 / $17,378.01	Facility		$1,659.59	$9,120.11	$17,378.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,412.54 / $2,089.30	Professional		$1,047.13	$1,412.54	$2,089.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $3,890.45 / $4,570.88	Facility		$1,819.70	$3,890.45	$4,570.88
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $1,737.80 / $2,818.38	Facility		$1,584.89	$1,737.80	$2,818.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,412.54 / $1,737.80 / $2,951.21	Professional		$1,412.54	$1,737.80	$2,951.21
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $2,454.71	Facility		$1,737.80	$1,737.80	$2,454.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $3,090.30 / $5,248.07	Facility		$1,737.80	$3,090.30	$5,248.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $2,089.30	Professional		$1,584.89	$1,584.89	$2,089.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $2,630.27 / $4,786.30	Facility		$1,862.09	$2,630.27	$4,786.30
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,584.89 / $1,949.84	Professional		$1,479.11	$1,584.89	$1,949.84
United Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $2,089.30 / $2,089.30	Facility		$1,737.80	$2,089.30	$2,089.30
United Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $1,949.84	Professional		$741.31	$741.31	$1,949.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,737.80 / $3,162.28	Professional		$794.33	$1,737.80	$3,162.28