Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $154.88 / $302.00	Facility	26	$93.33	$154.88	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $147.91 / $338.84	Professional		$104.71	$147.91	$338.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $281.84 / $416.87	Professional		$162.18	$281.84	$416.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $190.55 / $1,122.02	Facility	26	$107.15	$190.55	$1,122.02
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $275.42 / $380.19	Professional		$173.78	$275.42	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $52.48	Professional		$32.36	$33.11	$52.48
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $134.90 / $165.96 / $165.96	Facility	26	$134.90	$165.96	$165.96
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $69.18 / $69.18	Professional		$69.18	$69.18	$69.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Facility	26	$112.20	$112.20	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $389.05	Professional		$181.97	$302.00	$389.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $489.78	Facility	26	$489.78	$489.78	$489.78
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $288.40 / $389.05	Professional		$186.21	$288.40	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $147.91 / $371.54	Professional		$114.82	$147.91	$371.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $181.97 / $257.04	Professional		$134.90	$181.97	$257.04