Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,754.23 / $2,754.23 / $6,606.93	Facility		$2,754.23	$2,754.23	$6,606.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $2,344.23 / $3,890.45	Professional		$1,862.09	$2,344.23	$3,890.45
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $3,311.31 / $3,311.31 / $3,311.31	Professional		$3,311.31	$3,311.31	$3,311.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,454.71	Facility		$2,454.71	$2,454.71	$2,454.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $2,454.71	Professional		$1,778.28	$1,778.28	$2,454.71
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $5,888.44 / $12,302.69	Facility		$2,454.71	$5,888.44	$12,302.69
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $5,128.61 / $9,120.11	Professional		$2,454.71	$5,128.61	$9,120.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $3,311.31 / $3,630.78	Professional		$75.86	$3,311.31	$3,630.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,388.44 / $4,168.69 / $4,466.84	Facility		$3,388.44	$4,168.69	$4,466.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $3,890.45 / $4,265.80 / $4,466.84	Professional		$3,890.45	$4,265.80	$4,466.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,715.35 / $6,309.57 / $9,120.11	Facility		$3,715.35	$6,309.57	$9,120.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $4,677.35	Professional		$3,548.13	$3,548.13	$4,677.35
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $4,168.69 / $4,168.69 / $4,168.69	Facility		$4,168.69	$4,168.69	$4,168.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,715.35 / $4,786.30	Professional		$3,548.13	$3,715.35	$4,786.30
United Facility/Professional Facility Modifier Low / Median / High Price $2,570.40 / $6,456.54 / $6,456.54	Facility		$2,570.40	$6,456.54	$6,456.54
United Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,630.27 / $3,715.35	Professional		$1,819.70	$2,630.27	$3,715.35
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $3,090.30 / $3,715.35 / $6,606.93	Professional		$3,090.30	$3,715.35	$6,606.93