Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $173.78 / $208.93	Facility		$95.50	$173.78	$208.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $104.71	Professional		$87.10	$87.10	$104.71
Cigna Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $83.18 / $169.82	Facility		$83.18	$83.18	$169.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $107.15	Professional		$87.10	$87.10	$107.15
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $50.12	Professional		$50.12	$50.12	$50.12
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $91.20 / $165.96	Facility		$87.10	$91.20	$165.96
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $91.20 / $245.47	Facility		$79.43	$91.20	$245.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $91.20 / $100.00	Professional		$85.11	$91.20	$100.00
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $87.10 / $117.49	Facility		$75.86	$87.10	$117.49
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
United Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Facility		$87.10	$87.10	$87.10
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $87.10	Professional		$87.10	$87.10	$87.10
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $112.20	Professional		$87.10	$87.10	$112.20