Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $6,025.60 / $18,620.87	Facility		$1,862.09	$6,025.60	$18,620.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,230.27 / $3,090.30	Professional		$933.25	$1,230.27	$3,090.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $630.96 / $758.58 / $8,317.64	Facility		$630.96	$758.58	$8,317.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,000.00 / $1,659.59 / $3,090.30	Professional		$1,000.00	$1,659.59	$3,090.30
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $2,187.76 / $7,762.47	Facility		$1,202.26	$2,187.76	$7,762.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $2,041.74 / $5,248.07	Professional		$1,096.48	$2,041.74	$5,248.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,949.84 / $2,187.76	Facility		$1,621.81	$1,949.84	$2,187.76
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,348.96 / $1,348.96 / $1,778.28	Facility		$1,348.96	$1,348.96	$1,778.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $2,089.30 / $2,818.38	Professional		$1,348.96	$2,089.30	$2,818.38
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $10,964.78 / $16,595.87 / $31,622.78	Facility		$10,964.78	$16,595.87	$31,622.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,905.46 / $2,570.40	Professional		$1,380.38	$1,905.46	$2,570.40
United Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $17,782.79 / $33,884.42	Facility		$3,467.37	$17,782.79	$33,884.42
United Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,548.82 / $2,818.38	Professional		$1,071.52	$1,548.82	$2,818.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,047.13 / $1,737.80	Professional		$912.01	$1,047.13	$1,737.80