Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $10,232.93 / $28,183.83	Facility		$1,862.09	$10,232.93	$28,183.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,778.28 / $2,344.23	Professional		$1,288.25	$1,778.28	$2,344.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $5,754.40 / $5,754.40 / $5,754.40	Professional		$5,754.40	$5,754.40	$5,754.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Professional		$64.57	$64.57	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $1,995.26	Facility		$1,778.28	$1,778.28	$1,995.26
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Facility		$2,454.71	$2,454.71	$2,454.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $3,981.07 / $5,248.07	Professional		$2,454.71	$3,981.07	$5,248.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $3,467.37 / $4,786.30	Professional		$2,454.71	$3,467.37	$4,786.30
United Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $3,311.31 / $37,153.52	Facility		$1,122.02	$3,311.31	$37,153.52
United Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,951.21 / $4,897.79	Professional		$1,862.09	$2,951.21	$4,897.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,570.40 / $3,630.78	Professional		$2,187.76	$2,570.40	$3,630.78