Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $97.72 / $162.18 / $794.33	Facility	26	$97.72	$162.18	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $125.89 / $288.40	Professional	26	$87.10	$125.89	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $181.97 / $281.84	Professional	26	$109.65	$181.97	$281.84
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $213.80 / $12,589.25	Facility	26	$138.04	$213.80	$12,589.25
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $199.53 / $251.19	Professional	26	$138.04	$199.53	$251.19
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $169.82 / $173.78	Facility	26	$141.25	$169.82	$173.78
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $141.25 / $173.78	Professional	26	$95.50	$141.25	$173.78
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Facility	26	$117.49	$117.49	$117.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $194.98 / $251.19	Professional	26	$117.49	$194.98	$251.19
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $4,365.16 / $4,365.16 / $4,365.16	Facility	26	$4,365.16	$4,365.16	$4,365.16
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $186.21 / $251.19	Professional	26	$147.91	$186.21	$251.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $95.50 / $245.47	Professional	26	$75.86	$95.50	$245.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $117.49 / $165.96	Professional	26	$102.33	$117.49	$165.96