Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $2,630.27	Facility		$1,096.48	$1,096.48	$2,630.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,071.52 / $1,122.02	Professional		$1,047.13	$1,071.52	$1,122.02
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,995.26	Facility		$1,096.48	$1,096.48	$1,995.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Professional		$1,096.48	$1,096.48	$1,096.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $2,818.38 / $3,467.37	Facility		$1,445.44	$2,818.38	$3,467.37
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,818.38 / $3,715.35	Professional		$1,819.70	$2,818.38	$3,715.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $1,348.96	Professional		$32.36	$33.11	$1,348.96
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $2,398.83	Facility		$1,230.27	$1,230.27	$2,398.83
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional		$1,230.27	$1,230.27	$1,230.27
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Facility		$1,230.27	$1,230.27	$1,230.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional		$1,230.27	$1,230.27	$1,230.27
United Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $1,288.25	Professional		$1,230.27	$1,230.27	$1,288.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,621.81 / $1,737.80	Professional		$1,230.27	$1,621.81	$1,737.80