Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $141.25 / $218.78 / $602.56	Facility		$141.25	$218.78	$602.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $93.33 / $199.53	Professional		$75.86	$93.33	$199.53
Cigna Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $229.09 / $331.13	Facility		$107.15	$229.09	$331.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $117.49 / $194.98	Professional		$64.57	$117.49	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $79.43 / $109.65	Professional		$66.07	$79.43	$109.65
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $102.33 / $181.97	Facility		$102.33	$102.33	$181.97
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $181.97 / $309.03	Facility		$102.33	$181.97	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $123.03	Professional		$93.33	$93.33	$123.03
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $107.15 / $154.88 / $281.84	Facility		$107.15	$154.88	$281.84
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $93.33 / $102.33	Professional		$77.62	$93.33	$102.33
United Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $123.03 / $123.03	Facility		$102.33	$123.03	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $51.29 / $114.82	Professional		$43.65	$51.29	$114.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $46.77 / $186.21	Professional		$46.77	$46.77	$186.21