Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $16.98 / $16.98 / $16.98	Facility		$16.98	$16.98	$16.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.00 / $16.98 / $19.95	Professional		$10.00	$16.98	$19.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $16.98 / $16.98	Professional		$16.98	$16.98	$16.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $23.44 / $75.86	Professional		$19.05	$23.44	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $19.50 / $23.99	Facility		$19.05	$19.50	$23.99
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $19.05 / $28.84 / $41.69	Facility		$19.05	$28.84	$41.69
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $19.05 / $19.05	Professional		$19.05	$19.05	$19.05
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $22.91 / $27.54 / $52.48	Facility		$22.91	$27.54	$52.48
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $16.98 / $16.98	Professional		$16.98	$16.98	$16.98
United Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $29.51 / $53.70	Professional		$18.20	$29.51	$53.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $16.98 / $30.20	Professional		$16.98	$16.98	$30.20