Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $91.20 / $120.23	Facility	26	$56.23	$91.20	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $123.03 / $257.04	Professional		$89.13	$123.03	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $48.98 / $123.03	Professional	26	$31.62	$48.98	$123.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	26	$36.31	$36.31	$36.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $177.83 / $316.23	Professional		$93.33	$177.83	$316.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $64.57 / $134.90	Professional	26	$34.67	$64.57	$134.90
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $72.44 / $2,630.27	Facility	26	$40.74	$72.44	$2,630.27
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $208.93 / $288.40	Professional		$114.82	$208.93	$288.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $69.18 / $112.20	Professional	26	$32.36	$69.18	$112.20
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 $56.23 / $79.43 / $97.72	Facility	26	$56.23	$79.43	$97.72
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $89.13	Professional	26	$44.67	$58.88	$89.13
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $66.07 / $66.07	Facility	26	$66.07	$66.07	$66.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $234.42 / $309.03	Professional		$147.91	$234.42	$309.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $107.15 / $144.54	Professional	26	$66.07	$107.15	$144.54
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,754.23 / $2,754.23 / $2,754.23	Facility	26	$2,754.23	$2,754.23	$2,754.23
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $229.09 / $302.00	Professional		$151.36	$229.09	$302.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $97.72 / $134.90	Professional	26	$66.07	$97.72	$134.90
United Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $123.03 / $281.84	Professional		$93.33	$123.03	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $39.81 / $102.33	Professional	26	$33.88	$39.81	$102.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $125.89 / $208.93	Professional		$109.65	$125.89	$208.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $56.23 / $91.20	Professional	26	$48.98	$56.23	$91.20