Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $346.74 / $489.78	Facility		$218.78	$346.74	$489.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $218.78 / $6,760.83	Professional		$199.53	$218.78	$6,760.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $199.53 / $407.38	Facility		$186.21	$199.53	$407.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $245.47	Professional		$199.53	$199.53	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $64.57 / $75.86	Professional		$64.57	$64.57	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $204.17 / $234.42 / $389.05	Facility		$204.17	$234.42	$389.05
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $194.98 / $245.47 / $588.84	Facility		$194.98	$245.47	$588.84
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $223.87 / $245.47	Professional		$208.93	$223.87	$245.47
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $269.15 / $660.69	Facility		$199.53	$269.15	$660.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Professional		$199.53	$199.53	$199.53
United Facility/Professional Facility Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Facility		$199.53	$199.53	$199.53
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $239.88	Professional		$199.53	$199.53	$239.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $218.78 / $257.04	Professional		$199.53	$218.78	$257.04