Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $114.82 / $147.91	Facility	26	$70.79	$114.82	$147.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $269.15 / $645.65	Professional		$208.93	$269.15	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $144.54	Professional	26	$44.67	$58.88	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $416.87 / $870.96	Professional		$234.42	$416.87	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $89.13 / $162.18	Professional	26	$54.95	$89.13	$162.18
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $104.71 / $758.58	Facility	26	$63.10	$104.71	$758.58
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $436.52 / $691.83	Professional		$229.09	$436.52	$691.83
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $100.00 / $138.04	Professional	26	$52.48	$100.00	$138.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $64.57	Professional		$32.36	$33.11	$64.57
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $104.71 / $107.15	Facility	26	$87.10	$104.71	$107.15
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $79.43 / $107.15	Professional	26	$63.10	$79.43	$107.15
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $70.79 / $70.79 / $72.44	Facility	26	$70.79	$70.79	$72.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $575.44 / $933.25	Professional		$389.05	$575.44	$933.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $112.20 / $154.88	Professional	26	$72.44	$112.20	$154.88
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $512.86 / $512.86	Facility	26	$512.86	$512.86	$512.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $707.95	Professional		$338.84	$478.63	$707.95
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $102.33 / $138.04	Professional	26	$72.44	$102.33	$138.04
United Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $338.84 / $660.69	Professional		$229.09	$338.84	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $77.62 / $144.54	Professional	26	$53.70	$77.62	$144.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $407.38 / $676.08	Professional		$67.61	$407.38	$676.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $63.10 / $104.71	Professional	26	$54.95	$63.10	$104.71