Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $1,659.59 / $7,943.28 / $19,498.45	Facility		$1,659.59	$7,943.28	$19,498.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,174.90 / $1,548.82 / $1,698.24	Professional		$1,174.90	$1,548.82	$1,698.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $2,041.74 / $4,365.16 / $5,011.87	Facility		$2,041.74	$4,365.16	$5,011.87
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $1,737.80 / $1,949.84 / $8,128.31	Facility		$1,737.80	$1,949.84	$8,128.31
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,548.82 / $1,949.84 / $3,311.31	Professional		$1,548.82	$1,949.84	$3,311.31
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 $1,737.80 / $2,137.96 / $3,388.44	Facility		$1,737.80	$2,137.96	$3,388.44
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $3,388.44 / $5,888.44	Facility		$1,949.84	$3,388.44	$5,888.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,737.80 / $1,737.80 / $2,344.23	Professional		$1,737.80	$1,737.80	$2,344.23
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $2,041.74 / $2,951.21 / $5,370.32	Facility		$2,041.74	$2,951.21	$5,370.32
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,737.80 / $2,344.23	Professional		$1,659.59	$1,737.80	$2,344.23
United Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $2,344.23 / $2,344.23	Facility		$1,949.84	$2,344.23	$2,344.23
United Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $812.83 / $1,949.84	Professional		$741.31	$812.83	$1,949.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,949.84 / $3,548.13	Professional		$870.96	$1,949.84	$3,548.13