Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $89.13 / $144.54	Facility	26	$44.67	$89.13	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $102.33 / $269.15	Professional		$74.13	$102.33	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $39.81 / $93.33	Professional	26	$32.36	$39.81	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $165.96 / $323.59	Professional		$89.13	$165.96	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $66.07 / $123.03	Professional	26	$37.15	$66.07	$123.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $79.43 / $302.00	Facility	26	$44.67	$79.43	$302.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $169.82 / $281.84	Professional		$87.10	$169.82	$281.84
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $70.79 / $104.71	Professional	26	$38.90	$70.79	$104.71
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $79.43 / $83.18	Facility	26	$67.61	$79.43	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $89.13	Professional	26	$48.98	$70.79	$89.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $53.70 / $53.70 / $56.23	Facility	26	$53.70	$53.70	$56.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $234.42 / $323.59	Professional		$151.36	$234.42	$323.59
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $91.20 / $120.23	Professional	26	$56.23	$91.20	$120.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $302.00	Professional		$144.54	$213.80	$302.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $85.11 / $114.82	Professional	26	$57.54	$85.11	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $120.23 / $269.15	Professional		$91.20	$120.23	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $45.71 / $104.71	Professional	26	$37.15	$45.71	$104.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $131.83 / $218.78	Professional		$114.82	$131.83	$218.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $47.86 / $79.43	Professional	26	$41.69	$47.86	$79.43