Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $169.82 / $281.84	Facility	26	$123.03	$169.82	$281.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $426.58 / $870.96	Professional		$275.42	$426.58	$870.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $549.54 / $1,023.29	Professional		$275.42	$549.54	$1,023.29
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $151.36 / $1,000.00	Facility	26	$87.10	$151.36	$1,000.00
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $645.65 / $891.25	Professional		$380.19	$645.65	$891.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $125.89	Professional		$32.36	$33.11	$125.89
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $151.36 / $154.88	Facility	26	$125.89	$151.36	$154.88
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $436.52 / $436.52	Professional		$436.52	$436.52	$436.52
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $104.71	Facility	26	$102.33	$102.33	$104.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $630.96 / $812.83	Professional		$380.19	$630.96	$812.83
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $602.56 / $812.83	Professional		$389.05	$602.56	$812.83
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $457.09 / $870.96	Professional		$269.15	$457.09	$870.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $316.23 / $524.81	Professional		$275.42	$316.23	$524.81