Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.50 / $190.55 / $309.03	Facility	26	$95.50	$190.55	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $457.09 / $1,023.29	Professional		$281.84	$457.09	$1,023.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $416.87	Professional	26	$85.11	$141.25	$416.87
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $141.25	Professional	26	$134.90	$134.90	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $549.54 / $1,023.29	Professional		$281.84	$549.54	$1,023.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $125.89 / $245.47	Professional	26	$70.79	$125.89	$245.47
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $165.96 / $1,096.48	Facility	26	$104.71	$165.96	$1,096.48
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $371.54 / $645.65 / $851.14	Professional		$371.54	$645.65	$851.14
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $158.49 / $218.78	Professional	26	$87.10	$158.49	$218.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $138.04 / $165.96 / $169.82	Facility	26	$138.04	$165.96	$169.82
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $147.91 / $186.21	Professional	26	$102.33	$147.91	$186.21
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $630.96 / $831.76	Professional		$389.05	$630.96	$831.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $181.97 / $245.47	Professional	26	$114.82	$181.97	$245.47
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $602.56 / $812.83	Professional		$398.11	$602.56	$812.83
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $177.83 / $234.42	Professional	26	$117.49	$177.83	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $446.68 / $870.96	Professional		$269.15	$446.68	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $97.72 / $234.42	Professional	26	$75.86	$97.72	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $323.59 / $537.03	Professional		$281.84	$323.59	$537.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $158.49	Professional	26	$83.18	$95.50	$158.49