Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,288.25 / $1,288.25 / $3,090.30	Facility		$1,288.25	$1,288.25	$3,090.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,047.13 / $1,659.59	Professional		$776.25	$1,047.13	$1,659.59
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,096.48	Facility		$1,096.48	$1,096.48	$1,096.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $812.83 / $1,096.48	Professional		$812.83	$812.83	$1,096.48
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,148.15 / $2,754.23 / $5,495.41	Facility		$1,148.15	$2,754.23	$5,495.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $2,454.71 / $4,265.80	Professional		$1,148.15	$2,454.71	$4,265.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,479.11 / $1,621.81	Professional		$75.86	$1,479.11	$1,621.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,862.09 / $2,238.72	Facility		$1,513.56	$1,862.09	$2,238.72
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $1,905.46 / $2,238.72	Professional		$1,905.46	$1,905.46	$2,238.72
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $2,818.38 / $4,073.80	Facility		$1,659.59	$2,818.38	$4,073.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $2,089.30	Professional		$1,584.89	$1,584.89	$2,089.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $1,862.09	Facility		$1,862.09	$1,862.09	$1,862.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,659.59 / $2,137.96	Professional		$1,584.89	$1,659.59	$2,137.96
United Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $2,884.03 / $2,884.03	Facility		$870.96	$2,884.03	$2,884.03
United Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $933.25 / $1,659.59	Professional		$812.83	$933.25	$1,659.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,659.59 / $2,951.21	Professional		$1,348.96	$1,659.59	$2,951.21