Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $127.50 / $127.50 / $127.50	Facility		$127.50	$127.50	$127.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $127.50 / $127.50	Professional		$120.00	$127.50	$127.50
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $135.00 / $150.00 / $562.50	Facility		$135.00	$150.00	$562.50
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $138.22 / $570.00 / $600.00	Professional		$138.22	$570.00	$600.00
Cigna Facility/Professional Facility Modifier Low / Median / High Price $127.50 / $127.50 / $255.00	Facility		$127.50	$127.50	$255.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.50 / $127.50 / $127.50	Professional		$127.50	$127.50	$127.50
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $12.82 / $12.82 / $12.82	Professional		$12.82	$12.82	$12.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.00 / $50.00 / $75.00	Professional		$50.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $79,999.20 / $79,999.20 / $79,999.20	Facility		$79,999.20	$79,999.20	$79,999.20
United Facility/Professional Facility Modifier Low / Median / High Price $150.00 / $150.00 / $150.00	Facility		$150.00	$150.00	$150.00
United Facility/Professional Professional Modifier Low / Median / High Price $150.00 / $150.00 / $180.00	Professional		$150.00	$150.00	$180.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $127.50 / $127.50 / $127.50	Professional		$127.50	$127.50	$127.50