Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $3,630.78	Facility		$1,513.56	$1,513.56	$3,630.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,047.13 / $1,995.26	Professional		$831.76	$1,047.13	$1,995.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,513.56 / $1,513.56	Facility		$1,513.56	$1,513.56	$1,513.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,096.48 / $1,513.56	Professional		$1,096.48	$1,096.48	$1,513.56
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 $1,096.48 / $2,630.27 / $4,265.80	Professional		$1,096.48	$2,630.27	$4,265.80
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 $1,737.80 / $1,862.09 / $2,344.23	Facility		$1,737.80	$1,862.09	$2,344.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,344.23 / $2,344.23	Professional		$1,778.28	$2,344.23	$2,344.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,041.74 / $3,467.37 / $5,011.87	Facility		$2,041.74	$3,467.37	$5,011.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $2,570.40	Professional		$1,949.84	$1,949.84	$2,570.40
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $2,290.87	Facility		$2,290.87	$2,290.87	$2,290.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,041.74 / $2,630.27	Professional		$1,949.84	$2,041.74	$2,630.27
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 / $1,659.59	Professional		$831.76	$1,174.90	$1,659.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,659.59 / $3,630.78	Professional		$1,071.52	$1,659.59	$3,630.78