Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $52.48 / $257.04	Facility	26	$32.36	$52.48	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $95.50 / $234.42	Professional		$75.86	$95.50	$234.42
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.92 / $32.36 / $45.71	Facility	26	$6.92	$32.36	$45.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $158.49 / $295.12	Professional		$93.33	$158.49	$295.12
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $33.88 / $53.70 / $97.72	Facility	26	$33.88	$53.70	$97.72
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $257.04	Professional		$107.15	$181.97	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $54.95 / $56.23	Facility	26	$45.71	$54.95	$56.23
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $58.88 / $58.88	Professional		$58.88	$58.88	$58.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.90	Facility	26	$38.02	$38.02	$38.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $208.93 / $269.15	Professional		$128.82	$208.93	$269.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $263.03	Professional		$128.82	$190.55	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $107.15 / $234.42	Professional		$93.33	$107.15	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $109.65 / $181.97	Professional		$95.50	$109.65	$181.97