Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $35.48 / $66.07	Facility	26	$20.42	$35.48	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $100.00 / $275.42	Professional		$66.07	$100.00	$275.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $169.82 / $186.21	Professional		$169.82	$169.82	$186.21
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $134.90 / $288.40	Professional		$72.44	$134.90	$288.40
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $20.42 / $35.48 / $630.96	Facility	26	$20.42	$35.48	$630.96
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $144.54 / $245.47	Professional		$74.13	$144.54	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $54.95	Professional		$32.36	$33.11	$54.95
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $35.48 / $36.31	Facility	26	$29.51	$35.48	$36.31
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $24.55 / $24.55	Facility	26	$24.55	$24.55	$24.55
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $204.17 / $269.15	Professional		$128.82	$204.17	$269.15
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $190.55 / $269.15	Professional		$134.90	$190.55	$269.15
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $97.72 / $239.88	Professional		$72.44	$97.72	$239.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $107.15 / $177.83	Professional		$93.33	$107.15	$177.83