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 / $6,760.83	Facility		$2,818.38	$2,818.38	$6,760.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,398.83 / $3,981.07	Professional		$1,905.46	$2,398.83	$3,981.07
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,511.89 / $2,511.89 / $2,511.89	Facility		$2,511.89	$2,511.89	$2,511.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $2,511.89	Professional		$1,819.70	$1,819.70	$2,511.89
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,511.89 / $6,025.60 / $12,589.25	Facility		$2,511.89	$6,025.60	$12,589.25
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,511.89 / $5,248.07 / $9,332.54	Professional		$2,511.89	$5,248.07	$9,332.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $3,388.44 / $3,715.35	Professional		$75.86	$3,388.44	$3,715.35
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $4,265.80 / $4,570.88	Facility		$3,467.37	$4,265.80	$4,570.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $3,981.07 / $4,365.16 / $4,570.88	Professional		$3,981.07	$4,365.16	$4,570.88
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $6,456.54 / $9,332.54	Facility		$3,801.89	$6,456.54	$9,332.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,630.78 / $3,630.78 / $4,786.30	Professional		$3,630.78	$3,630.78	$4,786.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,265.80 / $4,265.80 / $4,265.80	Facility		$4,265.80	$4,265.80	$4,265.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,630.78 / $3,801.89 / $4,897.79	Professional		$3,630.78	$3,801.89	$4,897.79
United Facility/Professional Facility Modifier Low / Median / High Price $2,630.27 / $6,606.93 / $6,606.93	Facility		$2,630.27	$6,606.93	$6,606.93
United Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,691.53 / $3,801.89	Professional		$1,862.09	$2,691.53	$3,801.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3,090.30 / $3,801.89 / $6,760.83	Professional		$3,090.30	$3,801.89	$6,760.83