Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $7,413.10	Facility		$3,162.28	$3,162.28	$7,413.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,454.71 / $4,168.69	Professional		$1,819.70	$2,454.71	$4,168.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Facility		$3,388.44	$3,388.44	$3,388.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $3,388.44	Professional		$2,454.71	$2,454.71	$3,388.44
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $6,025.60 / $13,803.84	Facility		$2,570.40	$6,025.60	$13,803.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $5,623.41 / $9,772.37	Professional		$2,570.40	$5,623.41	$9,772.37
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $3,715.35 / $4,073.80	Professional		$75.86	$3,715.35	$4,073.80
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,801.89 / $4,677.35 / $4,897.79	Facility		$3,801.89	$4,677.35	$4,897.79
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $4,365.16 / $4,897.79 / $4,897.79	Professional		$4,365.16	$4,897.79	$4,897.79
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $4,265.80 / $7,079.46 / $10,471.29	Facility		$4,265.80	$7,079.46	$10,471.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,981.07 / $3,981.07 / $5,248.07	Professional		$3,981.07	$3,981.07	$5,248.07
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,677.35 / $4,677.35 / $4,677.35	Facility		$4,677.35	$4,677.35	$4,677.35
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,981.07 / $4,168.69 / $5,495.41	Professional		$3,981.07	$4,168.69	$5,495.41
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 / $2,691.53 / $3,890.45	Professional		$1,905.46	$2,691.53	$3,890.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3,467.37 / $4,168.69 / $7,413.10	Professional		$3,467.37	$4,168.69	$7,413.10