Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $5,011.87	Facility		$2,089.30	$2,089.30	$5,011.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,659.59 / $3,019.95	Professional		$1,230.27	$1,659.59	$3,019.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $2,089.30	Facility		$2,089.30	$2,089.30	$2,089.30
Cigna 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
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $4,073.80 / $9,120.11	Facility		$1,737.80	$4,073.80	$9,120.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $3,801.89 / $6,456.54	Professional		$1,737.80	$3,801.89	$6,456.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $2,454.71 / $2,754.23	Professional		$75.86	$2,454.71	$2,754.23
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $3,019.95 / $3,235.94	Facility		$2,570.40	$3,019.95	$3,235.94
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,884.03 / $3,235.94 / $3,235.94	Professional		$2,884.03	$3,235.94	$3,235.94
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,818.38 / $4,786.30 / $6,918.31	Facility		$2,818.38	$4,786.30	$6,918.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $2,691.53 / $3,548.13	Professional		$2,691.53	$2,691.53	$3,548.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $3,162.28	Facility		$3,162.28	$3,162.28	$3,162.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $2,818.38 / $3,630.78	Professional		$2,691.53	$2,818.38	$3,630.78
United Facility/Professional Facility Modifier Low / Median / High Price $1,584.89 / $4,466.84 / $4,466.84	Facility		$1,584.89	$4,466.84	$4,466.84
United Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,819.70 / $2,630.27	Professional		$1,288.25	$1,819.70	$2,630.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $2,818.38 / $4,897.79	Professional		$2,290.87	$2,818.38	$4,897.79