Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $501.19 / $1,122.02	Facility		$104.71	$501.19	$1,122.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $89.13 / $134.90	Professional		$75.86	$89.13	$134.90
Cigna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $251.19 / $288.40	Facility		$117.49	$251.19	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $128.82 / $162.18	Professional		$128.82	$128.82	$162.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $44.67 / $50.12 / $64.57	Professional		$44.67	$50.12	$64.57
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $169.82	Facility		$112.20	$112.20	$169.82
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $194.98 / $338.84	Facility		$112.20	$194.98	$338.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $100.00 / $134.90	Professional		$100.00	$100.00	$134.90
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $169.82 / $309.03	Facility		$117.49	$169.82	$309.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $100.00 / $112.20	Professional		$83.18	$100.00	$112.20
United Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $134.90 / $134.90	Facility		$112.20	$134.90	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $46.77 / $112.20	Professional		$46.77	$46.77	$112.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $199.53	Professional		$50.12	$50.12	$199.53