Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,818.38 / $2,818.38 / $6,606.93	Facility		$2,818.38	$2,818.38	$6,606.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,995.26 / $3,630.78	Professional		$1,445.44	$1,995.26	$3,630.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,630.27 / $2,630.27 / $2,630.27	Facility		$2,630.27	$2,630.27	$2,630.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $1,905.46 / $2,630.27	Professional		$1,905.46	$1,905.46	$2,630.27
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $5,011.87 / $12,302.69	Facility		$2,089.30	$5,011.87	$12,302.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,089.30 / $4,897.79 / $8,128.31	Professional		$2,089.30	$4,897.79	$8,128.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $3,311.31 / $3,630.78	Professional		$75.86	$3,311.31	$3,630.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $4,073.80 / $4,265.80	Facility		$3,388.44	$4,073.80	$4,265.80
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $3,890.45 / $4,265.80 / $4,265.80	Professional		$3,890.45	$4,265.80	$4,265.80
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $6,309.57 / $9,120.11	Facility		$3,801.89	$6,309.57	$9,120.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $4,677.35	Professional		$3,548.13	$3,548.13	$4,677.35
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,168.69 / $4,168.69 / $4,168.69	Facility		$4,168.69	$4,168.69	$4,168.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,715.35 / $4,786.30	Professional		$3,548.13	$3,715.35	$4,786.30
United Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $5,370.32 / $5,370.32	Facility		$2,187.76	$5,370.32	$5,370.32
United Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $2,238.72 / $3,162.28	Professional		$1,548.82	$2,238.72	$3,162.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3,090.30 / $3,715.35 / $6,606.93	Professional		$3,090.30	$3,715.35	$6,606.93