Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $107.15 / $181.97	Facility	26	$52.48	$107.15	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $426.58 / $831.76	Professional		$331.13	$426.58	$831.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $707.95 / $1,258.93	Professional		$380.19	$707.95	$1,258.93
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $95.50 / $1,380.38	Facility	26	$58.88	$95.50	$1,380.38
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $489.78 / $831.76 / $1,174.90	Professional		$489.78	$831.76	$1,174.90
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 $79.43 / $95.50 / $102.33	Facility	26	$79.43	$95.50	$102.33
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $64.57 / $66.07	Facility	26	$64.57	$64.57	$66.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $562.34 / $912.01 / $1,174.90	Professional		$562.34	$912.01	$1,174.90
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	26	$954.99	$954.99	$954.99
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $891.25 / $1,148.15	Professional		$575.44	$891.25	$1,148.15
United Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $478.63 / $1,071.52	Professional		$380.19	$478.63	$1,071.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $478.63 / $776.25	Professional		$416.87	$478.63	$776.25