Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $15.14 / $23.99 / $51.29	Professional		$15.14	$23.99	$51.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $45.71 / $63.10	Professional		$23.99	$45.71	$63.10
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $54.95 / $114.82	Facility		$26.30	$54.95	$114.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $69.18 / $123.03	Professional		$26.30	$69.18	$123.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $20.89 / $32.36 / $33.11	Professional		$20.89	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $27.54 / $45.71	Facility		$26.30	$27.54	$45.71
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $26.30 / $26.30	Professional		$26.30	$26.30	$26.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.44 / $23.44 / $33.11	Professional		$23.44	$23.44	$33.11
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $22.39 / $23.44 / $29.51	Professional		$22.39	$23.44	$29.51
United Facility/Professional Facility Modifier Low / Median / High Price $25.12 / $25.12 / $25.12	Facility		$25.12	$25.12	$25.12
United Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $26.30 / $53.70	Professional		$15.85	$26.30	$53.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $11.75 / $11.75 / $11.75	Professional		$11.75	$11.75	$11.75