Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $8,128.31	Facility		$3,467.37	$3,467.37	$8,128.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,454.71 / $4,466.84	Professional		$1,778.28	$2,454.71	$4,466.84
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Facility		$2,570.40	$2,570.40	$2,570.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $2,570.40	Professional		$1,862.09	$1,862.09	$2,570.40
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $6,309.57 / $15,135.61	Facility		$2,570.40	$6,309.57	$15,135.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $6,025.60 / $10,000.00	Professional		$2,570.40	$6,025.60	$10,000.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $4,073.80 / $4,466.84	Professional		$75.86	$4,073.80	$4,466.84
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $4,265.80 / $4,570.88 / $5,370.32	Facility		$4,265.80	$4,570.88	$5,370.32
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $4,570.88 / $5,370.32 / $5,370.32	Professional		$4,570.88	$5,370.32	$5,370.32
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,677.35 / $7,762.47 / $11,481.54	Facility		$4,677.35	$7,762.47	$11,481.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $4,466.84 / $4,466.84 / $5,888.44	Professional		$4,466.84	$4,466.84	$5,888.44
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,248.07 / $5,248.07 / $5,248.07	Facility		$5,248.07	$5,248.07	$5,248.07
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $4,365.16 / $4,570.88 / $6,025.60	Professional		$4,365.16	$4,570.88	$6,025.60
United Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $6,606.93 / $6,606.93	Facility		$2,691.53	$6,606.93	$6,606.93
United Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,754.23 / $3,890.45	Professional		$1,905.46	$2,754.23	$3,890.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3,801.89 / $4,570.88 / $8,128.31	Professional		$3,801.89	$4,570.88	$8,128.31