Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $257.04 / $257.04	Facility		$257.04	$257.04	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $131.83 / $257.04	Professional		$109.65	$131.83	$257.04
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $162.18 / $302.00 / $5,128.61	Facility		$162.18	$302.00	$5,128.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $269.15 / $338.84	Professional		$151.36	$269.15	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $64.57	Professional		$44.67	$50.12	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $234.42 / $269.15 / $281.84	Facility		$234.42	$269.15	$281.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $275.42 / $275.42	Professional		$275.42	$275.42	$275.42