Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $173.78 / $234.42	Facility	26	$109.65	$173.78	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $199.53 / $426.58	Professional		$120.23	$199.53	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $363.08	Professional	26	$52.48	$95.50	$363.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	26	$151.36	$151.36	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $316.23 / $562.34	Professional		$147.91	$316.23	$562.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $112.20 / $257.04	Professional	26	$56.23	$112.20	$257.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $120.23 / $7,413.10	Facility	26	$66.07	$120.23	$7,413.10
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $316.23 / $446.68	Professional		$169.82	$316.23	$446.68
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $109.65 / $213.80	Professional	26	$52.48	$109.65	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $58.88	Professional		$32.36	$33.11	$58.88
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $177.83 / $186.21	Facility	26	$89.13	$177.83	$186.21
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $100.00 / $169.82	Professional	26	$66.07	$100.00	$169.82
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $125.89 / $125.89	Facility	26	$125.89	$125.89	$125.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $380.19 / $512.86	Professional		$234.42	$380.19	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $208.93 / $275.42	Professional	26	$125.89	$208.93	$275.42
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $9,332.54 / $9,332.54 / $9,332.54	Facility	26	$9,332.54	$9,332.54	$9,332.54
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $338.84 / $478.63	Professional		$234.42	$338.84	$478.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $117.49 / $186.21 / $263.03	Professional	26	$117.49	$186.21	$263.03
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $501.19	Professional		$165.96	$239.88	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $100.00 / $239.88	Professional	26	$56.23	$100.00	$239.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $199.53 / $323.59	Professional		$173.78	$199.53	$323.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $104.71 / $173.78	Professional	26	$91.20	$104.71	$173.78