Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $154.88 / $257.04	Facility	26	$114.82	$154.88	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $562.34 / $1,288.25	Professional		$416.87	$562.34	$1,288.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $112.20 / $234.42	Professional	26	$70.79	$112.20	$234.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $891.25 / $1,380.38	Professional		$501.19	$891.25	$1,380.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $141.25 / $213.80	Professional	26	$89.13	$141.25	$213.80
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $144.54 / $177.83	Facility	26	$89.13	$144.54	$177.83
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $851.14 / $1,122.02	Professional		$501.19	$851.14	$1,122.02
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $144.54 / $181.97	Professional	26	$89.13	$144.54	$181.97
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 $114.82 / $138.04 / $141.25	Facility	26	$114.82	$138.04	$141.25
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $123.03 / $154.88	Professional	26	$93.33	$123.03	$154.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $95.50	Facility	26	$93.33	$93.33	$95.50
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $977.24 / $1,202.26	Professional		$588.84	$977.24	$1,202.26
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $158.49 / $204.17	Professional	26	$95.50	$158.49	$204.17
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $812.83 / $1,096.48	Professional		$588.84	$812.83	$1,096.48
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $138.04 / $181.97	Professional	26	$95.50	$138.04	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $398.11 / $1,148.15	Professional		$346.74	$398.11	$1,148.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $66.07 / $181.97	Professional	26	$60.26	$66.07	$181.97
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $602.56 / $851.14	Professional		$446.68	$602.56	$851.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $95.50 / $134.90	Professional	26	$70.79	$95.50	$134.90