Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $140.00 / $317.80 / $331.80	Facility		$140.00	$317.80	$331.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.00 / $140.00 / $140.00	Professional		$140.00	$140.00	$140.00
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $91.95 / $285.00 / $285.00	Facility		$91.95	$285.00	$285.00
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $229.88 / $266.75 / $390.10	Professional		$229.88	$266.75	$390.10
Cigna Facility/Professional Facility Modifier Low / Median / High Price $223.29 / $223.29 / $223.29	Facility		$223.29	$223.29	$223.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $163.00 / $163.00 / $223.29	Professional		$163.00	$163.00	$223.29
Molina Facility/Professional Professional Modifier Low / Median / High Price $45.00 / $50.00 / $75.00	Professional		$45.00	$50.00	$75.00
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $328.68 / $328.68 / $328.68	Facility		$328.68	$328.68	$328.68
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $328.68 / $328.68 / $328.68	Professional		$328.68	$328.68	$328.68
United Facility/Professional Professional Modifier Low / Median / High Price $170.65 / $184.87 / $284.41	Professional		$170.65	$184.87	$284.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $244.14 / $244.14 / $266.75	Professional		$244.14	$244.14	$266.75