Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $147.91 / $288.40	Facility	26	$89.13	$147.91	$288.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $407.38 / $870.96	Professional		$213.80	$407.38	$870.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $478.63 / $912.01	Professional		$436.52	$478.63	$912.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $89.13 / $128.82	Facility	26	$19.05	$89.13	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $416.87 / $812.83	Professional		$218.78	$416.87	$812.83
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $154.88 / $1,513.56	Facility	26	$93.33	$154.88	$1,513.56
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $489.78 / $691.83	Professional		$245.47	$489.78	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $128.82 / $154.88 / $162.18	Facility	26	$128.82	$154.88	$162.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $575.44 / $741.31	Professional		$354.81	$575.44	$741.31
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $933.25 / $933.25 / $933.25	Facility	26	$933.25	$933.25	$933.25
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $524.81 / $724.44	Professional		$363.08	$524.81	$724.44
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $281.84 / $676.08	Professional		$208.93	$281.84	$676.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $316.23 / $512.86	Professional		$275.42	$316.23	$512.86