Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $3,548.13	Facility		$1,513.56	$1,513.56	$3,548.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,122.02 / $1,949.84	Professional		$831.76	$1,122.02	$1,949.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Facility		$1,174.90	$1,174.90	$1,174.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $851.14 / $1,174.90	Professional		$851.14	$851.14	$1,174.90
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $2,818.38 / $6,309.57	Facility		$1,174.90	$2,818.38	$6,309.57
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $2,630.27 / $4,466.84	Professional		$1,174.90	$2,630.27	$4,466.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,698.24 / $1,862.09	Professional		$75.86	$1,698.24	$1,862.09
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,862.09 / $2,238.72	Facility		$1,778.28	$1,862.09	$2,238.72
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,238.72 / $2,238.72	Professional		$1,862.09	$2,238.72	$2,238.72
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $3,235.94 / $4,786.30	Facility		$1,949.84	$3,235.94	$4,786.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $2,511.89	Professional		$1,862.09	$1,862.09	$2,511.89
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $2,187.76 / $2,187.76	Facility		$2,187.76	$2,187.76	$2,187.76
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,949.84 / $2,511.89	Professional		$1,819.70	$1,949.84	$2,511.89
United Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $3,090.30 / $3,090.30	Facility		$933.25	$3,090.30	$3,090.30
United Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,071.52 / $1,778.28	Professional		$870.96	$1,071.52	$1,778.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,949.84 / $3,388.44	Professional		$1,584.89	$1,949.84	$3,388.44