Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $2,290.87 / $2,818.38	Facility		$1,174.90	$2,290.87	$2,818.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $954.99 / $1,621.81	Professional		$758.58	$954.99	$1,621.81
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,445.44	Facility		$1,174.90	$1,174.90	$1,445.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $851.14 / $1,445.44	Professional		$851.14	$851.14	$1,445.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $2,511.89 / $5,011.87	Facility		$1,071.52	$2,511.89	$5,011.87
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $2,238.72 / $3,890.45	Professional		$1,071.52	$2,238.72	$3,890.45
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,348.96 / $1,479.11	Professional		$75.86	$1,348.96	$1,479.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $1,698.24 / $1,819.70	Facility		$1,380.38	$1,698.24	$1,819.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,737.80 / $1,819.70	Professional		$1,584.89	$1,737.80	$1,819.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $2,570.40 / $3,715.35	Facility		$1,513.56	$2,570.40	$3,715.35
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,445.44 / $1,905.46	Professional		$1,445.44	$1,445.44	$1,905.46
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $1,698.24 / $1,698.24	Facility		$1,698.24	$1,698.24	$1,698.24
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,513.56 / $1,949.84	Professional		$1,445.44	$1,513.56	$1,949.84
United Facility/Professional Facility Modifier Low / Median / High Price $794.33 / $2,630.27 / $2,630.27	Facility		$794.33	$2,630.27	$2,630.27
United Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $851.14 / $1,513.56	Professional		$741.31	$851.14	$1,513.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,513.56 / $2,691.53	Professional		$1,258.93	$1,513.56	$2,691.53