Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $19.95 / $19.95 / $19.95	Facility		$19.95	$19.95	$19.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $12.88 / $19.95	Professional		$10.96	$12.88	$19.95
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $16.60 / $31.62 / $2,570.40	Facility		$16.60	$31.62	$2,570.40
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $14.79 / $25.70 / $38.02	Professional		$14.79	$25.70	$38.02
Molina Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $50.12 / $75.86	Professional		$33.11	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $21.88 / $28.84 / $29.51	Facility		$21.88	$28.84	$29.51
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $40.74 / $40.74	Professional		$40.74	$40.74	$40.74