Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $107.15 / $123.03	Professional		$52.48	$107.15	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $61.66 / $61.66	Professional		$61.66	$61.66	$61.66
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $144.54 / $346.74	Facility		$91.20	$144.54	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $138.04 / $288.40	Professional		$91.20	$138.04	$288.40
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $128.82 / $131.83 / $147.91	Facility		$128.82	$131.83	$147.91
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $10,000.00 / $10,000.00 / $10,000.00	Facility		$10,000.00	$10,000.00	$10,000.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $10,000.00 / $10,000.00 / $10,000.00	Professional		$10,000.00	$10,000.00	$10,000.00
United Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Facility		$213.80	$213.80	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $64.57 / $123.03	Professional		$50.12	$64.57	$123.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $114.82 / $173.78	Professional		$114.82	$114.82	$173.78