Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $457.09 / $10,232.93 / $28,183.83	Facility		$457.09	$10,232.93	$28,183.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $269.15 / $457.09	Professional		$234.42	$269.15	$457.09
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $316.23 / $630.96 / $5,128.61	Facility		$316.23	$630.96	$5,128.61
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $575.44 / $741.31	Professional		$295.12	$575.44	$741.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $75.86	Professional		$44.67	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $501.19 / $588.84 / $616.60	Facility		$501.19	$588.84	$616.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Professional		$512.86	$512.86	$512.86