Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $64.57 / $97.72	Facility	26	$43.65	$64.57	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $125.89 / $295.12	Professional		$85.11	$125.89	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $39.81 / $97.72	Professional	26	$21.88	$39.81	$97.72
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $52.48 / $67.61	Professional	26	$28.84	$52.48	$67.61
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $177.83 / $363.08	Professional		$95.50	$177.83	$363.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $46.77 / $107.15	Professional	26	$23.99	$46.77	$107.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $51.29 / $316.23	Facility	26	$27.54	$51.29	$316.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $199.53 / $316.23	Professional		$104.71	$199.53	$316.23
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $46.77 / $89.13	Professional	26	$22.39	$46.77	$89.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $56.23	Professional		$32.36	$33.11	$56.23
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $72.44 / $77.62	Facility	26	$38.90	$72.44	$77.62
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $97.72	Professional		$97.72	$97.72	$97.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $42.66 / $75.86	Professional	26	$30.90	$42.66	$75.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $269.15 / $346.74	Professional		$165.96	$269.15	$346.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $85.11 / $114.82	Professional	26	$51.29	$85.11	$114.82
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 $173.78 / $245.47 / $346.74	Professional		$173.78	$245.47	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $107.15	Professional	26	$50.12	$75.86	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $125.89 / $309.03	Professional		$93.33	$125.89	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $41.69 / $97.72	Professional	26	$23.99	$41.69	$97.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $141.25 / $234.42	Professional		$123.03	$141.25	$234.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $43.65 / $72.44	Professional	26	$38.02	$43.65	$72.44