Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $4,786.30	Facility		$1,995.26	$1,995.26	$4,786.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,778.28 / $3,311.31	Professional		$1,318.26	$1,778.28	$3,311.31
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,238.72 / $2,238.72 / $2,238.72	Facility		$2,238.72	$2,238.72	$2,238.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $1,905.46 / $2,238.72	Professional		$1,905.46	$1,905.46	$2,238.72
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $4,365.16 / $8,912.51	Facility		$1,862.09	$4,365.16	$8,912.51
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $3,630.78 / $6,760.83	Professional		$1,862.09	$3,630.78	$6,760.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $2,951.21 / $3,162.28	Professional		$64.57	$2,951.21	$3,162.28
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,454.71 / $2,951.21 / $3,090.30	Facility		$2,454.71	$2,951.21	$3,090.30
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $2,818.38 / $2,951.21 / $3,090.30	Professional		$2,818.38	$2,951.21	$3,090.30
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,691.53 / $4,570.88 / $6,606.93	Facility		$2,691.53	$4,570.88	$6,606.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,570.40 / $3,388.44	Professional		$2,570.40	$2,570.40	$3,388.44
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,019.95 / $3,019.95 / $3,019.95	Facility		$3,019.95	$3,019.95	$3,019.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,570.40 / $2,691.53 / $3,467.37	Professional		$2,570.40	$2,691.53	$3,467.37
United Facility/Professional Facility Modifier Low / Median / High Price $776.25 / $4,786.30 / $4,786.30	Facility		$776.25	$4,786.30	$4,786.30
United Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,949.84 / $2,818.38	Professional		$1,380.38	$1,949.84	$2,818.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,238.72 / $4,786.30	Professional		$1,778.28	$2,238.72	$4,786.30