Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,258.93 / $1,258.93 / $2,951.21	Facility		$1,258.93	$1,258.93	$2,951.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,071.52 / $1,905.46	Professional		$776.25	$1,071.52	$1,905.46
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,479.11 / $1,479.11 / $1,479.11	Facility		$1,479.11	$1,479.11	$1,479.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,479.11	Professional		$1,071.52	$1,071.52	$1,479.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,071.52 / $2,691.53 / $5,495.41	Facility		$1,071.52	$2,691.53	$5,495.41
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $2,238.72 / $3,981.07	Professional		$1,071.52	$2,238.72	$3,981.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $1,479.11 / $1,621.81	Professional		$75.86	$1,479.11	$1,621.81
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,513.56 / $1,698.24 / $1,949.84	Facility		$1,513.56	$1,698.24	$1,949.84
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $1,949.84 / $1,949.84	Professional		$1,698.24	$1,949.84	$1,949.84
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $2,818.38 / $4,168.69	Facility		$1,698.24	$2,818.38	$4,168.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,584.89 / $2,238.72	Professional		$1,584.89	$1,584.89	$2,238.72
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $1,862.09	Facility		$1,862.09	$1,862.09	$1,862.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $1,659.59 / $2,187.76	Professional		$1,584.89	$1,659.59	$2,187.76
United Facility/Professional Facility Modifier Low / Median / High Price $1,122.02 / $2,818.38 / $2,818.38	Facility		$1,122.02	$2,818.38	$2,818.38
United Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,148.15 / $1,621.81	Professional		$812.83	$1,148.15	$1,621.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,047.13 / $1,380.38 / $2,951.21	Professional		$1,047.13	$1,380.38	$2,951.21