Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.54 / $57.54 / $57.54	Facility		$57.54	$57.54	$57.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $57.54 / $66.07	Professional		$30.90	$57.54	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $57.54	Professional		$57.54	$57.54	$57.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $75.86	Professional		$58.88	$58.88	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $67.61 / $69.18	Facility		$67.61	$67.61	$69.18
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $64.57	Professional		$64.57	$64.57	$64.57
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $67.61 / $102.33 / $147.91	Facility		$67.61	$102.33	$147.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $67.61 / $67.61	Professional		$67.61	$67.61	$67.61
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $102.33 / $194.98	Facility		$87.10	$102.33	$194.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $60.26	Professional		$60.26	$60.26	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $74.13 / $173.78	Professional		$54.95	$74.13	$173.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $107.15	Professional		$60.26	$60.26	$107.15