Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $194.98 / $416.87 / $676.08	Facility	26	$194.98	$416.87	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $645.65 / $1,318.26	Professional		$489.78	$645.65	$1,318.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $169.82 / $208.93 / $512.86	Professional	26	$169.82	$208.93	$512.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,258.93 / $1,949.84	Professional		$741.31	$1,258.93	$1,949.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $398.11 / $602.56	Professional	26	$245.47	$398.11	$602.56
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $257.04 / $457.09 / $3,235.94	Facility	26	$257.04	$457.09	$3,235.94
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $794.33 / $1,318.26 / $1,737.80	Professional		$794.33	$1,318.26	$1,737.80
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $257.04 / $416.87 / $549.54	Professional	26	$257.04	$416.87	$549.54
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 $316.23 / $380.19 / $398.11	Facility	26	$316.23	$380.19	$398.11
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $331.13 / $398.11	Professional	26	$239.88	$331.13	$398.11
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $263.03 / $263.03 / $269.15	Facility	26	$263.03	$263.03	$269.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $1,348.96 / $1,778.28	Professional		$831.76	$1,348.96	$1,778.28
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $446.68 / $588.84	Professional	26	$269.15	$446.68	$588.84
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,380.38 / $1,380.38 / $1,380.38	Facility	26	$1,380.38	$1,380.38	$1,380.38
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,258.93 / $1,698.24	Professional		$812.83	$1,258.93	$1,698.24
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $416.87 / $562.34	Professional	26	$269.15	$416.87	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $758.58 / $1,548.82	Professional		$537.03	$758.58	$1,548.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $257.04 / $512.86	Professional	26	$177.83	$257.04	$512.86
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $630.96 / $851.14 / $1,202.26	Professional		$630.96	$851.14	$1,202.26
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $275.42 / $389.05	Professional	26	$204.17	$275.42	$389.05