Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $3,311.31 / $15,848.93 / $34,673.69	Facility		$3,311.31	$15,848.93	$34,673.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,290.87 / $3,090.30 / $4,168.69	Professional		$2,290.87	$3,090.30	$4,168.69
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,630.78 / $7,943.28 / $9,120.11	Facility		$3,630.78	$7,943.28	$9,120.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $3,467.37 / $16,218.10	Facility		$3,162.28	$3,467.37	$16,218.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $2,818.38 / $3,467.37 / $5,888.44	Professional		$2,818.38	$3,467.37	$5,888.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $75.86 / $75.86	Professional		$75.86	$75.86	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $3,162.28 / $3,890.45 / $6,165.95	Facility		$3,162.28	$3,890.45	$6,165.95
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $6,165.95 / $10,471.29	Facility		$3,467.37	$6,165.95	$10,471.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,162.28 / $3,162.28 / $4,168.69	Professional		$3,162.28	$3,162.28	$4,168.69
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $3,715.35 / $5,248.07 / $9,549.93	Facility		$3,715.35	$5,248.07	$9,549.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $2,951.21 / $3,162.28 / $4,168.69	Professional		$2,951.21	$3,162.28	$4,168.69
United Facility/Professional Facility Modifier Low / Median / High Price $3,467.37 / $4,168.69 / $4,168.69	Facility		$3,467.37	$4,168.69	$4,168.69
United Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,479.11 / $3,890.45	Professional		$1,479.11	$1,479.11	$3,890.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $3,467.37 / $6,309.57	Professional		$1,584.89	$3,467.37	$6,309.57