Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $4,073.80	Facility		$1,737.80	$1,737.80	$4,073.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,148.15 / $2,238.72	Professional		$870.96	$1,148.15	$2,238.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,202.26 / $1,202.26 / $1,202.26	Facility		$1,202.26	$1,202.26	$1,202.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $891.25 / $1,202.26	Professional		$891.25	$891.25	$1,202.26
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,230.27 / $3,019.95 / $7,413.10	Facility		$1,230.27	$3,019.95	$7,413.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $2,884.03 / $4,677.35	Professional		$1,202.26	$2,884.03	$4,677.35
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,778.28 / $2,187.76	Professional		$75.86	$1,778.28	$2,187.76
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $2,041.74 / $2,570.40	Facility		$1,905.46	$2,041.74	$2,570.40
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,570.40 / $2,570.40	Professional		$1,949.84	$2,570.40	$2,570.40
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $3,801.89 / $5,495.41	Facility		$2,238.72	$3,801.89	$5,495.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,818.38	Professional		$2,137.96	$2,137.96	$2,818.38
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Facility		$2,511.89	$2,511.89	$2,511.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,238.72 / $2,884.03	Professional		$2,137.96	$2,238.72	$2,884.03
United Facility/Professional Facility Modifier Low / Median / High Price $954.99 / $3,162.28 / $3,162.28	Facility		$954.99	$3,162.28	$3,162.28
United Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,047.13 / $1,819.70	Professional		$891.25	$1,047.13	$1,819.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,238.72 / $3,981.07	Professional		$1,819.70	$2,238.72	$3,981.07