Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $199.53 / $338.84	Facility	26	$128.82	$199.53	$338.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $134.90 / $371.54	Professional	26	$95.50	$134.90	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $186.21 / $295.12	Professional	26	$114.82	$186.21	$295.12
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $144.54 / $223.87 / $6,918.31	Facility	26	$144.54	$223.87	$6,918.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $208.93 / $257.04	Professional	26	$144.54	$208.93	$257.04
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $147.91 / $177.83 / $186.21	Facility	26	$147.91	$177.83	$186.21
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $165.96 / $194.98	Professional	26	$107.15	$165.96	$194.98
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $125.89	Facility	26	$123.03	$123.03	$125.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $204.17 / $263.03	Professional	26	$123.03	$204.17	$263.03
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Facility	26	$2,884.03	$2,884.03	$2,884.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $190.55 / $257.04	Professional	26	$151.36	$190.55	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $100.00 / $257.04	Professional	26	$81.28	$100.00	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $169.82	Professional	26	$102.33	$120.23	$169.82