Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Facility		$162.18	$162.18	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $147.91 / $177.83	Professional		$107.15	$147.91	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $524.81 / $524.81	Professional		$524.81	$524.81	$524.81
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Professional		$50.12	$50.12	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $309.03 / $316.23	Facility		$257.04	$309.03	$316.23
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $204.17 / $213.80	Facility		$204.17	$204.17	$213.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $331.13 / $457.09	Professional		$213.80	$331.13	$457.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $416.87	Professional		$208.93	$295.12	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $239.88 / $416.87	Professional		$162.18	$239.88	$416.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $69.18 / $69.18	Professional		$69.18	$69.18	$69.18