Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,890.45 / $7,244.36 / $25,118.86	Facility		$3,890.45	$7,244.36	$25,118.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $3,388.44 / $7,585.78	Professional		$2,570.40	$3,388.44	$7,585.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $4,073.80 / $8,912.51 / $10,000.00	Facility		$4,073.80	$8,912.51	$10,000.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $4,073.80 / $5,248.07	Professional		$1,862.09	$4,073.80	$5,248.07
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $3,715.35 / $4,786.30 / $12,022.64	Facility		$3,715.35	$4,786.30	$12,022.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $4,786.30 / $10,232.93	Professional		$3,715.35	$4,786.30	$10,232.93
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 $3,890.45 / $3,890.45 / $5,754.40	Facility		$3,890.45	$3,890.45	$5,754.40
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,890.45 / $6,760.83 / $11,748.98	Facility		$3,890.45	$6,760.83	$11,748.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $4,677.35	Professional		$3,467.37	$3,467.37	$4,677.35
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,073.80 / $5,754.40 / $10,715.19	Facility		$4,073.80	$5,754.40	$10,715.19
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,311.31 / $3,467.37 / $4,677.35	Professional		$3,311.31	$3,467.37	$4,677.35
United Facility/Professional Facility Modifier Low / Median / High Price $3,890.45 / $4,677.35 / $4,677.35	Facility		$3,890.45	$4,677.35	$4,677.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $4,365.16	Professional		$1,621.81	$1,621.81	$4,365.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $3,890.45 / $6,918.31	Professional		$1,737.80	$3,890.45	$6,918.31