Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $4,168.69	Facility		$1,737.80	$1,737.80	$4,168.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,479.11 / $2,454.71	Professional		$1,174.90	$1,479.11	$2,454.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility		$1,778.28	$1,778.28	$1,778.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,318.26 / $1,778.28	Professional		$1,318.26	$1,318.26	$1,778.28
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,548.82 / $3,890.45 / $7,762.47	Facility		$1,548.82	$3,890.45	$7,762.47
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $3,467.37 / $5,754.40	Professional		$1,548.82	$3,467.37	$5,754.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $2,089.30 / $2,290.87	Professional		$75.86	$2,089.30	$2,290.87
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,630.27 / $2,691.53 / $2,818.38	Facility		$2,630.27	$2,691.53	$2,818.38
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,137.96 / $2,137.96 / $2,137.96	Professional		$2,137.96	$2,137.96	$2,137.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,344.23 / $3,981.07 / $5,754.40	Facility		$2,344.23	$3,981.07	$5,754.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,238.72 / $2,951.21	Professional		$2,238.72	$2,238.72	$2,951.21
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,630.27 / $2,630.27 / $2,630.27	Facility		$2,630.27	$2,630.27	$2,630.27
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,344.23 / $3,019.95	Professional		$2,238.72	$2,344.23	$3,019.95
United Facility/Professional Facility Modifier Low / Median / High Price $1,621.81 / $3,981.07 / $3,981.07	Facility		$1,621.81	$3,981.07	$3,981.07
United Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,659.59 / $2,344.23	Professional		$1,148.15	$1,659.59	$2,344.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,905.46 / $4,168.69	Professional		$1,479.11	$1,905.46	$4,168.69