Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,187.76 / $2,187.76 / $2,187.76	Facility		$2,187.76	$2,187.76	$2,187.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $2,187.76	Professional		$1,949.84	$1,949.84	$2,187.76
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,862.09 / $1,862.09 / $1,949.84	Facility		$1,862.09	$1,862.09	$1,949.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $288.40 / $467.74	Facility		$169.82	$288.40	$467.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $281.84 / $363.08	Professional		$165.96	$281.84	$363.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $30.20 / $60.26	Professional		$30.20	$30.20	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $1,949.84 / $2,454.71	Facility		$1,778.28	$1,949.84	$2,454.71
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $2,089.30 / $2,089.30 / $2,238.72	Facility		$2,089.30	$2,089.30	$2,238.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,041.74 / $2,089.30 / $2,089.30	Professional		$2,041.74	$2,089.30	$2,089.30
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Facility		$125.89	$125.89	$125.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $131.83	Professional		$125.89	$125.89	$131.83
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $151.36 / $2,238.72	Professional		$125.89	$151.36	$2,238.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04