Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $4,168.69	Facility		$1,737.80	$1,737.80	$4,168.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,698.24 / $1,778.28	Professional		$1,659.59	$1,698.24	$1,778.28
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $13,182.57	Facility		$1,737.80	$1,737.80	$13,182.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $1,737.80	Professional		$1,737.80	$1,737.80	$1,737.80
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $3,630.78 / $4,365.16	Facility		$1,819.70	$3,630.78	$4,365.16
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $3,630.78 / $4,897.79	Professional		$2,290.87	$3,630.78	$4,897.79
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $2,137.96	Professional		$32.36	$33.11	$2,137.96
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $3,235.94	Facility		$1,949.84	$1,949.84	$3,235.94
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Facility		$1,949.84	$1,949.84	$1,949.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Facility		$1,949.84	$1,949.84	$1,949.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
United Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $933.25 / $933.25	Facility		$933.25	$933.25	$933.25
United Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $1,698.24 / $2,041.74	Professional		$1,698.24	$1,698.24	$2,041.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,344.23 / $2,511.89	Professional		$1,949.84	$2,344.23	$2,511.89