Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $4,786.30	Facility		$1,995.26	$1,995.26	$4,786.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,230.27 / $1,698.24 / $2,630.27	Professional		$1,230.27	$1,698.24	$2,630.27
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,041.74 / $2,041.74 / $2,041.74	Facility		$2,041.74	$2,041.74	$2,041.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $2,041.74	Professional		$1,513.56	$1,513.56	$2,041.74
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $4,265.80 / $8,912.51	Facility		$1,778.28	$4,265.80	$8,912.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $3,715.35 / $6,606.93	Professional		$1,778.28	$3,715.35	$6,606.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $2,398.83 / $2,630.27	Professional		$75.86	$2,398.83	$2,630.27
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,019.95 / $3,090.30 / $3,467.37	Facility		$3,019.95	$3,090.30	$3,467.37
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Professional		$2,454.71	$2,454.71	$2,454.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $4,570.88 / $6,606.93	Facility		$2,691.53	$4,570.88	$6,606.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $3,548.13	Professional		$2,570.40	$2,570.40	$3,548.13
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Facility		$3,019.95	$3,019.95	$3,019.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,691.53 / $3,467.37	Professional		$2,570.40	$2,691.53	$3,467.37
United Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $4,677.35 / $4,677.35	Facility		$1,862.09	$4,677.35	$4,677.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,905.46 / $2,691.53	Professional		$1,348.96	$1,905.46	$2,691.53
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,691.53 / $4,786.30	Professional		$2,238.72	$2,691.53	$4,786.30