Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $4,897.79	Facility		$2,089.30	$2,089.30	$4,897.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,737.80 / $2,691.53	Professional		$1,288.25	$1,737.80	$2,691.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $1,819.70	Facility		$1,819.70	$1,819.70	$1,819.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,819.70	Professional		$1,318.26	$1,318.26	$1,819.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $4,570.88 / $8,912.51	Facility		$1,949.84	$4,570.88	$8,912.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $3,981.07 / $7,079.46	Professional		$1,949.84	$3,981.07	$7,079.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $2,398.83 / $2,630.27	Professional		$75.86	$2,398.83	$2,630.27
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $3,019.95 / $3,090.30	Facility		$2,454.71	$3,019.95	$3,090.30
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $3,090.30 / $3,090.30	Professional		$2,951.21	$3,090.30	$3,090.30
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $4,570.88 / $6,606.93	Facility		$2,691.53	$4,570.88	$6,606.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $3,548.13	Professional		$2,570.40	$2,570.40	$3,548.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Facility		$3,019.95	$3,019.95	$3,019.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,691.53 / $3,467.37	Professional		$2,570.40	$2,691.53	$3,467.37
United Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $4,786.30 / $4,786.30	Facility		$1,445.44	$4,786.30	$4,786.30
United Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,659.59 / $2,754.23	Professional		$1,348.96	$1,659.59	$2,754.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,187.76 / $2,691.53 / $4,786.30	Professional		$2,187.76	$2,691.53	$4,786.30