Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,754.23 / $2,884.03 / $3,467.37	Professional		$2,754.23	$2,884.03	$3,467.37
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $2,754.23 / $6,760.83	Facility		$1,122.02	$2,754.23	$6,760.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,122.02 / $2,630.27 / $4,365.16	Professional		$1,122.02	$2,630.27	$4,365.16
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,819.70 / $1,995.26	Professional		$75.86	$1,819.70	$1,995.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,905.46 / $2,344.23	Facility		$1,862.09	$1,905.46	$2,344.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,344.23 / $2,344.23	Professional		$1,905.46	$2,344.23	$2,344.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $3,467.37 / $5,128.61	Facility		$2,089.30	$3,467.37	$5,128.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $2,691.53	Professional		$1,949.84	$1,949.84	$2,691.53
United Facility/Professional Facility Modifier Low / Median / High Price $1,174.90 / $2,884.03 / $2,884.03	Facility		$1,174.90	$2,884.03	$2,884.03
United Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,174.90 / $1,698.24	Professional		$831.76	$1,174.90	$1,698.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,041.74 / $3,630.78	Professional		$1,698.24	$2,041.74	$3,630.78