Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $169.82 / $338.84	Facility	26	$102.33	$169.82	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $288.40 / $1,096.48	Professional		$151.36	$288.40	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $144.54 / $478.63	Professional	26	$75.86	$144.54	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $302.00 / $354.81	Professional		$151.36	$302.00	$354.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $162.18 / $181.97	Professional	26	$141.25	$162.18	$181.97
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.88 / $102.33 / $144.54	Facility	26	$21.88	$102.33	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $309.03 / $549.54	Professional		$181.97	$309.03	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $154.88 / $269.15	Professional	26	$89.13	$154.88	$269.15
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $177.83 / $562.34	Facility	26	$107.15	$177.83	$562.34
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $346.74 / $478.63	Professional		$213.80	$346.74	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $169.82 / $229.09	Professional	26	$100.00	$169.82	$229.09
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 $147.91 / $177.83 / $186.21	Facility	26	$147.91	$177.83	$186.21
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $125.89	Professional		$125.89	$125.89	$125.89
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $158.49 / $208.93	Professional	26	$109.65	$158.49	$208.93
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	26	$123.03	$123.03	$123.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $398.11 / $512.86	Professional		$245.47	$398.11	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $199.53 / $269.15	Professional	26	$123.03	$199.53	$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 $239.88 / $346.74 / $478.63	Professional		$239.88	$346.74	$478.63
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $181.97 / $251.19	Professional	26	$123.03	$181.97	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $204.17 / $436.52	Professional		$181.97	$204.17	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $100.00 / $234.42	Professional	26	$93.33	$100.00	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $218.78 / $354.81	Professional		$186.21	$218.78	$354.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $104.71 / $173.78	Professional	26	$91.20	$104.71	$173.78