Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,380.38 / $1,380.38 / $3,311.31	Facility		$1,380.38	$1,380.38	$3,311.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,148.15 / $2,041.74	Professional		$794.33	$1,148.15	$2,041.74
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 / $2,754.23 / $6,165.95	Facility		$1,174.90	$2,754.23	$6,165.95
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $2,511.89 / $4,365.16	Professional		$1,174.90	$2,511.89	$4,365.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,659.59 / $1,819.70	Professional		$75.86	$1,659.59	$1,819.70
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $2,089.30 / $2,511.89	Facility		$1,698.24	$2,089.30	$2,511.89
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,137.96 / $2,511.89	Professional		$1,949.84	$2,137.96	$2,511.89
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $3,162.28 / $4,570.88	Facility		$1,862.09	$3,162.28	$4,570.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $2,344.23	Professional		$1,778.28	$1,778.28	$2,344.23
Regence BlueShield 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
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $1,862.09 / $2,398.83	Professional		$1,778.28	$1,862.09	$2,398.83
United Facility/Professional Facility Modifier Low / Median / High Price $933.25 / $3,019.95 / $3,019.95	Facility		$933.25	$3,019.95	$3,019.95
United Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,230.27 / $1,778.28	Professional		$870.96	$1,230.27	$1,778.28
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $1,862.09 / $3,311.31	Professional		$1,548.82	$1,862.09	$3,311.31