Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $4,897.79	Facility		$2,089.30	$2,089.30	$4,897.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,737.80 / $2,754.23	Professional		$1,380.38	$1,737.80	$2,754.23
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $1,819.70 / $1,819.70	Facility		$1,819.70	$1,819.70	$1,819.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $1,548.82 / $1,819.70	Professional		$1,548.82	$1,548.82	$1,819.70
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,819.70 / $4,265.80 / $9,120.11	Facility		$1,819.70	$4,265.80	$9,120.11
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $3,715.35 / $6,760.83	Professional		$1,819.70	$3,715.35	$6,760.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $3,019.95 / $3,235.94	Professional		$64.57	$3,019.95	$3,235.94
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $2,511.89 / $3,019.95 / $3,162.28	Facility		$2,511.89	$3,019.95	$3,162.28
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $3,019.95 / $3,162.28 / $3,162.28	Professional		$3,019.95	$3,162.28	$3,162.28
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,818.38 / $4,677.35 / $6,918.31	Facility		$2,818.38	$4,677.35	$6,918.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,630.27 / $2,630.27 / $3,467.37	Professional		$2,630.27	$2,630.27	$3,467.37
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Facility		$3,090.30	$3,090.30	$3,090.30
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,630.27 / $2,754.23 / $3,548.13	Professional		$2,630.27	$2,754.23	$3,548.13
United Facility/Professional Facility Modifier Low / Median / High Price $758.58 / $4,677.35 / $4,677.35	Facility		$758.58	$4,677.35	$4,677.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,348.96 / $1,905.46 / $2,754.23	Professional		$1,348.96	$1,905.46	$2,754.23
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $2,290.87 / $4,897.79	Professional		$1,737.80	$2,290.87	$4,897.79