Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $53.70	Facility		$53.70	$53.70	$53.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.67 / $50.12 / $58.88	Professional		$34.67	$50.12	$58.88
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $38.02 / $162.18 / $275.42	Facility		$38.02	$162.18	$275.42
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $173.78	Professional		$173.78	$173.78	$173.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $60.26	Professional		$44.67	$50.12	$60.26
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $53.70 / $53.70 / $60.26	Facility		$53.70	$53.70	$60.26
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $67.61 / $79.43	Facility		$67.61	$67.61	$79.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $85.11 / $123.03	Professional		$79.43	$85.11	$123.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $77.62 / $107.15 / $204.17	Facility		$77.62	$107.15	$204.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $107.15 / $151.36	Professional		$69.18	$107.15	$151.36
United Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $141.25 / $251.19	Facility		$104.71	$141.25	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $79.43 / $158.49	Professional		$63.10	$79.43	$158.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $81.28 / $114.82	Professional		$69.18	$81.28	$114.82