Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $194.98 / $1,148.15	Facility		$102.33	$194.98	$1,148.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $100.00 / $275.42	Professional		$93.33	$100.00	$275.42
Cigna Facility/Professional Facility Modifier Low / Median / High Price $89.13 / $89.13 / $181.97	Facility		$89.13	$89.13	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $114.82	Professional		$93.33	$93.33	$114.82
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 $95.50 / $114.82 / $177.83	Facility		$95.50	$114.82	$177.83
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $83.18 / $104.71 / $251.19	Facility		$83.18	$104.71	$251.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $100.00 / $107.15	Professional		$93.33	$100.00	$107.15
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $91.20 / $109.65 / $263.03	Facility		$91.20	$109.65	$263.03
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
United Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Facility		$93.33	$93.33	$93.33
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $93.33 / $93.33	Professional		$93.33	$93.33	$93.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $91.20 / $123.03	Professional		$91.20	$91.20	$123.03