Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $3,801.89	Facility		$1,621.81	$1,621.81	$3,801.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,318.26 / $2,238.72	Professional		$1,023.29	$1,318.26	$2,238.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Facility		$1,621.81	$1,621.81	$1,621.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,621.81	Professional		$1,174.90	$1,174.90	$1,621.81
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $3,467.37 / $6,760.83	Facility		$1,380.38	$3,467.37	$6,760.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $3,019.95 / $5,128.61	Professional		$1,380.38	$3,019.95	$5,128.61
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,659.59 / $1,995.26	Professional		$75.86	$1,659.59	$1,995.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $2,344.23 / $2,511.89	Facility		$1,905.46	$2,344.23	$2,511.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,398.83 / $2,511.89	Professional		$2,137.96	$2,398.83	$2,511.89
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $3,467.37 / $5,128.61	Facility		$2,089.30	$3,467.37	$5,128.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $2,630.27	Professional		$1,995.26	$1,995.26	$2,630.27
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,344.23 / $2,344.23 / $2,344.23	Facility		$2,344.23	$2,344.23	$2,344.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,089.30 / $2,691.53	Professional		$1,949.84	$2,089.30	$2,691.53
United Facility/Professional Facility Modifier Low / Median / High Price $1,096.48 / $3,630.78 / $3,630.78	Facility		$1,096.48	$3,630.78	$3,630.78
United Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,174.90 / $2,089.30	Professional		$1,023.29	$1,174.90	$2,089.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,089.30 / $3,630.78	Professional		$1,698.24	$2,089.30	$3,630.78