Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $1,230.27 / $2,951.21	Facility		$1,230.27	$1,230.27	$2,951.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $831.76 / $1,584.89	Professional		$660.69	$831.76	$1,584.89
Cigna Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $851.14 / $851.14	Facility		$851.14	$851.14	$851.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $630.96 / $851.14	Professional		$630.96	$630.96	$851.14
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $870.96 / $2,137.96 / $5,248.07	Facility		$870.96	$2,137.96	$5,248.07
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $2,041.74 / $3,311.31	Professional		$870.96	$2,041.74	$3,311.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,258.93 / $1,548.82	Professional		$75.86	$1,258.93	$1,548.82
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,348.96 / $1,445.44 / $1,819.70	Facility		$1,348.96	$1,445.44	$1,819.70
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,819.70 / $1,819.70	Professional		$1,380.38	$1,819.70	$1,819.70
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $2,691.53 / $3,890.45	Facility		$1,584.89	$2,691.53	$3,890.45
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $2,089.30	Professional		$1,513.56	$1,513.56	$2,089.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility		$1,778.28	$1,778.28	$1,778.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,584.89 / $2,041.74	Professional		$1,513.56	$1,584.89	$2,041.74
United Facility/Professional Facility Modifier Low / Median / High Price $676.08 / $2,238.72 / $2,238.72	Facility		$676.08	$2,238.72	$2,238.72
United Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $741.31 / $1,318.26	Professional		$630.96	$741.31	$1,318.26
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,584.89 / $2,818.38	Professional		$1,318.26	$1,584.89	$2,818.38