Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $87.10 / $309.03	Facility	26	$43.65	$87.10	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $102.33 / $223.87	Professional		$57.54	$102.33	$223.87
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $575.44 / $575.44 / $575.44	Professional	50	$575.44	$575.44	$575.44
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.33 / $43.65 / $61.66	Facility	26	$9.33	$43.65	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $173.78 / $316.23	Professional		$85.11	$173.78	$316.23
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $112.20 / $346.74	Facility	26	$74.13	$112.20	$346.74
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $204.17 / $323.59	Professional		$134.90	$204.17	$323.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $77.62 / $169.82	Facility	26	$63.10	$77.62	$169.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $52.48	Facility	26	$51.29	$51.29	$52.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $158.49 / $208.93	Professional		$93.33	$158.49	$208.93
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $218.78 / $218.78	Facility	26	$218.78	$218.78	$218.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $144.54 / $245.47	Professional		$95.50	$144.54	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $147.91 / $251.19	Professional		$77.62	$147.91	$251.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $18.20 / $81.28 / $134.90	Professional		$18.20	$81.28	$134.90