Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $190.55 / $309.03	Facility	26	$100.00	$190.55	$309.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $338.84 / $870.96	Professional		$204.17	$338.84	$870.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $104.71 / $323.59	Professional	26	$70.79	$104.71	$323.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $144.54 / $154.88	Professional	26	$63.10	$144.54	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $549.54 / $1,000.00	Professional		$295.12	$549.54	$1,000.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $125.89 / $251.19	Professional	26	$72.44	$125.89	$251.19
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $165.96 / $489.78	Facility	26	$100.00	$165.96	$489.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $630.96 / $831.76	Professional		$354.81	$630.96	$831.76
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $154.88 / $213.80	Professional	26	$83.18	$154.88	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $138.04	Professional		$32.36	$33.11	$138.04
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 Low / Median / High Price $213.80 / $213.80 / $213.80	Professional		$213.80	$213.80	$213.80
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $151.36 / $181.97	Professional	26	$102.33	$151.36	$181.97
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 $416.87 / $691.83 / $891.25	Professional		$416.87	$691.83	$891.25
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 $346.74 / $346.74 / $346.74	Facility	26	$346.74	$346.74	$346.74
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $645.65 / $870.96	Professional		$426.58	$645.65	$870.96
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 $281.84 / $398.11 / $870.96	Professional		$281.84	$398.11	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $95.50 / $223.87	Professional	26	$74.13	$95.50	$223.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $316.23 / $512.86	Professional		$269.15	$316.23	$512.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $95.50 / $158.49	Professional	26	$83.18	$95.50	$158.49