Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,778.28 / $8,511.38 / $19,054.61	Facility		$1,778.28	$8,511.38	$19,054.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,513.56 / $3,630.78	Professional		$1,148.15	$1,513.56	$3,630.78
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $4,168.69 / $4,897.79	Facility		$1,995.26	$4,168.69	$4,897.79
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $1,905.46 / $8,709.64	Facility		$1,698.24	$1,905.46	$8,709.64
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $1,905.46 / $3,235.94	Professional		$1,513.56	$1,905.46	$3,235.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $75.86	Professional		$44.67	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $2,089.30 / $3,311.31	Facility		$1,698.24	$2,089.30	$3,311.31
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $3,311.31 / $5,754.40	Facility		$1,905.46	$3,311.31	$5,754.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $1,698.24 / $2,290.87	Professional		$1,698.24	$1,698.24	$2,290.87
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,995.26 / $2,818.38 / $5,011.87	Facility		$1,995.26	$2,818.38	$5,011.87
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,698.24 / $2,137.96	Professional		$1,621.81	$1,698.24	$2,137.96
United Facility/Professional Facility Modifier Low / Median / High Price $1,905.46 / $2,290.87 / $2,290.87	Facility		$1,905.46	$2,290.87	$2,290.87
United Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $794.33 / $2,137.96	Professional		$794.33	$794.33	$2,137.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $851.14 / $1,905.46 / $3,388.44	Professional		$851.14	$1,905.46	$3,388.44