Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $338.84	Facility		$144.54	$144.54	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $138.04 / $144.54	Professional		$134.90	$138.04	$144.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $144.54 / $288.40	Facility		$144.54	$144.54	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $75.86	Professional		$50.12	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $112.20 / $112.20 / $112.20	Facility		$112.20	$112.20	$112.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $144.54 / $309.03 / $467.74	Facility		$144.54	$309.03	$467.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $144.54 / $151.36	Professional		$128.82	$144.54	$151.36
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $102.33 / $102.33 / $154.88	Facility		$102.33	$102.33	$154.88
United Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Professional		$141.25	$141.25	$141.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $141.25 / $141.25	Professional		$141.25	$141.25	$141.25