Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $138.04 / $251.19	Facility	26	$72.44	$138.04	$251.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $245.47 / $724.44	Professional		$165.96	$245.47	$724.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $457.09 / $794.33	Professional		$251.19	$457.09	$794.33
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $162.18 / $1,584.89	Facility	26	$95.50	$162.18	$1,584.89
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $645.65	Professional		$275.42	$457.09	$645.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $107.15	Professional		$32.36	$33.11	$107.15
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $141.25 / $147.91	Facility	26	$117.49	$141.25	$147.91
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $97.72 / $100.00	Facility	26	$97.72	$97.72	$100.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $537.03 / $724.44	Professional		$338.84	$537.03	$724.44
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Facility	26	$660.69	$660.69	$660.69
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $512.86 / $691.83	Professional		$331.13	$512.86	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $275.42 / $602.56	Professional		$173.78	$275.42	$602.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $346.74 / $489.78	Professional		$257.04	$346.74	$489.78