Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $190.55 / $218.78	Facility		$109.65	$190.55	$218.78
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $173.78 / $213.80	Facility		$102.33	$173.78	$213.80
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $162.18 / $165.96	Facility		$134.90	$162.18	$165.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $114.82 / $114.82	Facility		$114.82	$114.82	$114.82
United Facility/Professional Facility Modifier Low / Median / High Price $190.55 / $660.69 / $6,165.95	Facility		$190.55	$660.69	$6,165.95