Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $2,187.76 / $5,128.61	Facility		$2,187.76	$2,187.76	$5,128.61
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 $1,737.80 / $1,737.80 / $1,737.80	Facility		$1,737.80	$1,737.80	$1,737.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $1,737.80	Professional		$1,258.93	$1,258.93	$1,737.80
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $4,168.69 / $9,549.93	Facility		$1,737.80	$4,168.69	$9,549.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $3,890.45 / $6,760.83	Professional		$1,737.80	$3,890.45	$6,760.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $2,570.40 / $2,818.38	Professional		$75.86	$2,570.40	$2,818.38
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $2,818.38 / $3,388.44	Facility		$2,691.53	$2,818.38	$3,388.44
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,818.38 / $3,388.44 / $3,388.44	Professional		$2,818.38	$3,388.44	$3,388.44
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,951.21 / $4,897.79 / $7,244.36	Facility		$2,951.21	$4,897.79	$7,244.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,754.23 / $2,754.23 / $3,630.78	Professional		$2,754.23	$2,754.23	$3,630.78
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,311.31 / $3,311.31 / $3,311.31	Facility		$3,311.31	$3,311.31	$3,311.31
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,754.23 / $2,884.03 / $3,801.89	Professional		$2,754.23	$2,884.03	$3,801.89
United Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $4,570.88 / $4,570.88	Facility		$1,621.81	$4,570.88	$4,570.88
United Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,862.09 / $2,630.27	Professional		$1,318.26	$1,862.09	$2,630.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $2,884.03 / $5,128.61	Professional		$2,398.83	$2,884.03	$5,128.61