Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $151.36 / $151.36	Facility		$151.36	$151.36	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $131.83 / $154.88	Professional		$91.20	$131.83	$154.88
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $309.03 / $6,456.54	Facility		$117.49	$309.03	$6,456.54
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $234.42 / $389.05	Professional		$117.49	$234.42	$389.05
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 $269.15 / $309.03 / $323.59	Facility		$269.15	$309.03	$323.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Professional		$165.96	$165.96	$165.96