Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.43 / $131.83 / $169.82	Facility	26	$79.43	$131.83	$169.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $144.54 / $275.42	Professional		$107.15	$144.54	$275.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $218.78 / $426.58	Professional		$104.71	$218.78	$426.58
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $83.18 / $158.49	Facility	26	$50.12	$83.18	$158.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $158.49 / $323.59	Professional		$89.13	$158.49	$323.59
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $77.62	Professional		$32.36	$33.11	$77.62
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $120.23 / $123.03	Facility	26	$100.00	$120.23	$123.03
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $83.18 / $83.18	Facility	26	$83.18	$83.18	$83.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $281.84 / $371.54	Professional		$190.55	$281.84	$371.54
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 $173.78 / $263.03 / $346.74	Professional		$173.78	$263.03	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $389.05	Professional		$128.82	$204.17	$389.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $151.36 / $257.04	Professional		$134.90	$151.36	$257.04