Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $4,365.16	Facility		$1,862.09	$1,862.09	$4,365.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $977.24 / $1,380.38 / $2,398.83	Professional		$977.24	$1,380.38	$2,398.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility		$1,513.56	$1,513.56	$1,513.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,513.56	Professional		$1,096.48	$1,096.48	$1,513.56
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,445.44 / $3,388.44 / $7,762.47	Facility		$1,445.44	$3,388.44	$7,762.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $3,235.94 / $5,495.41	Professional		$1,445.44	$3,235.94	$5,495.41
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $2,089.30 / $2,290.87	Professional		$75.86	$2,089.30	$2,290.87
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $2,691.53 / $2,754.23	Facility		$2,187.76	$2,691.53	$2,754.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $2,754.23 / $2,754.23	Professional		$2,691.53	$2,754.23	$2,754.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,398.83 / $3,981.07 / $5,888.44	Facility		$2,398.83	$3,981.07	$5,888.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $3,162.28	Professional		$2,290.87	$2,290.87	$3,162.28
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $2,691.53 / $2,691.53	Facility		$2,691.53	$2,691.53	$2,691.53
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,398.83 / $3,090.30	Professional		$2,238.72	$2,398.83	$3,090.30
United Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $3,715.35 / $3,715.35	Facility		$1,122.02	$3,715.35	$3,715.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,318.26 / $2,187.76	Professional		$1,047.13	$1,318.26	$2,187.76
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,398.83 / $4,168.69	Professional		$1,949.84	$2,398.83	$4,168.69