Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $79.43 / $138.04 / $169.82	Facility		$79.43	$138.04	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $77.62 / $154.88	Professional		$72.44	$77.62	$154.88
Cigna Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $69.18 / $147.91	Facility		$69.18	$69.18	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $89.13	Professional		$72.44	$72.44	$89.13
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 $70.79 / $83.18 / $134.90	Facility		$70.79	$83.18	$134.90
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $87.10 / $87.10 / $95.50	Facility		$87.10	$87.10	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $87.10 / $87.10	Professional		$72.44	$87.10	$87.10
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $72.44 / $72.44 / $93.33	Facility		$72.44	$72.44	$93.33
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $72.44	Professional		$72.44	$72.44	$72.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $72.44 / $95.50	Professional		$72.44	$72.44	$95.50