Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $39.81 / $61.66	Facility	26	$27.54	$39.81	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $97.72 / $275.42	Professional		$61.66	$97.72	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $30.90 / $95.50	Professional	26	$16.98	$30.90	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $40.74 / $50.12	Professional	26	$25.12	$40.74	$50.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $151.36 / $251.19	Professional		$79.43	$151.36	$251.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $33.88 / $69.18	Professional	26	$17.38	$33.88	$69.18
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $21.38 / $36.31 / $645.65	Facility	26	$21.38	$36.31	$645.65
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $162.18 / $234.42	Professional		$35.48	$162.18	$234.42
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $34.67 / $57.54	Professional	26	$16.60	$34.67	$57.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $46.77	Professional		$32.36	$33.11	$46.77
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $39.81 / $47.86	Facility	26	$28.18	$39.81	$47.86
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $380.19 / $380.19	Professional		$380.19	$380.19	$380.19
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $30.90 / $47.86	Professional	26	$20.89	$30.90	$47.86
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $32.36 / $33.11	Facility	26	$32.36	$32.36	$33.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $173.78 / $229.09	Professional		$107.15	$173.78	$229.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $52.48 / $72.44	Professional	26	$33.11	$52.48	$72.44
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 $104.71 / $162.18 / $245.47	Professional		$104.71	$162.18	$245.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $48.98 / $67.61	Professional	26	$33.11	$48.98	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $114.82 / $275.42	Professional		$75.86	$114.82	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $25.70 / $61.66	Professional	26	$17.78	$25.70	$61.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $97.72 / $162.18	Professional		$85.11	$97.72	$162.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $28.84 / $47.86	Professional	26	$25.12	$28.84	$47.86