Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $3,019.95 / $10,715.19	Facility		$1,621.81	$3,019.95	$10,715.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,318.26 / $3,090.30	Professional		$977.24	$1,318.26	$3,090.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $3,467.37 / $4,265.80	Facility		$1,698.24	$3,467.37	$4,265.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,905.46 / $2,344.23	Professional		$851.14	$1,905.46	$2,344.23
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,995.26 / $5,011.87	Facility		$1,621.81	$1,995.26	$5,011.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $2,041.74 / $4,466.84	Professional		$1,621.81	$2,041.74	$4,466.84
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 $1,621.81 / $1,621.81 / $3,090.30	Facility		$1,621.81	$1,621.81	$3,090.30
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $2,818.38 / $4,897.79	Facility		$1,621.81	$2,818.38	$4,897.79
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,479.11 / $1,949.84	Professional		$1,479.11	$1,479.11	$1,949.84
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $2,454.71 / $4,466.84	Facility		$1,698.24	$2,454.71	$4,466.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,479.11 / $1,778.28	Professional		$1,380.38	$1,479.11	$1,778.28
United Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,949.84 / $1,949.84	Facility		$1,621.81	$1,949.84	$1,949.84
United Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $676.08 / $1,819.70	Professional		$676.08	$676.08	$1,819.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $724.44 / $2,951.21	Professional		$724.44	$724.44	$2,951.21