Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,290.87 / $2,290.87 / $5,495.41	Facility		$2,290.87	$2,290.87	$5,495.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,949.84 / $3,090.30	Professional		$1,513.56	$1,949.84	$3,090.30
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Facility		$2,884.03	$2,884.03	$2,884.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,454.71 / $2,884.03	Professional		$2,454.71	$2,454.71	$2,884.03
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $2,041.74 / $4,786.30 / $10,232.93	Facility		$2,041.74	$4,786.30	$10,232.93
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,041.74 / $4,168.69 / $7,413.10	Professional		$2,041.74	$4,168.69	$7,413.10
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $3,388.44 / $3,630.78	Professional		$64.57	$3,388.44	$3,630.78
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,818.38 / $3,388.44 / $3,548.13	Facility		$2,818.38	$3,388.44	$3,548.13
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,548.13 / $3,548.13	Professional		$3,162.28	$3,548.13	$3,548.13
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,090.30 / $5,248.07 / $7,585.78	Facility		$3,090.30	$5,248.07	$7,585.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $2,951.21 / $3,890.45	Professional		$2,951.21	$2,951.21	$3,890.45
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,467.37	Facility		$3,467.37	$3,467.37	$3,467.37
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $3,090.30 / $3,981.07	Professional		$2,951.21	$3,090.30	$3,981.07
United Facility/Professional Facility Modifier Low / Median / High Price $851.14 / $5,248.07 / $5,248.07	Facility		$851.14	$5,248.07	$5,248.07
United Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,137.96 / $3,090.30	Professional		$1,513.56	$2,137.96	$3,090.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $2,511.89 / $5,495.41	Professional		$1,949.84	$2,511.89	$5,495.41