Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $165.96 / $269.15	Facility	26	$93.33	$165.96	$269.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $190.55 / $446.68	Professional		$144.54	$190.55	$446.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $194.98	Professional	26	$57.54	$77.62	$194.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Professional		$199.53	$199.53	$199.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $537.03	Professional		$169.82	$281.84	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $125.89 / $229.09	Professional	26	$77.62	$125.89	$229.09
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $147.91 / $323.59	Facility	26	$87.10	$147.91	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $323.59 / $478.63	Professional		$194.98	$323.59	$478.63
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $144.54 / $194.98	Professional	26	$83.18	$144.54	$194.98
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $66.07	Professional		$32.36	$33.11	$66.07
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $147.91 / $151.36	Facility	26	$112.20	$147.91	$151.36
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $123.03	Professional		$123.03	$123.03	$123.03
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $131.83 / $162.18	Professional	26	$89.13	$131.83	$162.18
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $102.33	Facility	26	$100.00	$100.00	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $389.05 / $512.86	Professional		$239.88	$389.05	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $169.82 / $229.09	Professional	26	$102.33	$169.82	$229.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
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 $102.33 / $151.36 / $204.17	Professional	26	$102.33	$151.36	$204.17
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $190.55 / $436.52	Professional		$169.82	$190.55	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $83.18 / $194.98	Professional	26	$75.86	$83.18	$194.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $213.80 / $354.81	Professional		$186.21	$213.80	$354.81
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $89.13 / $147.91	Professional	26	$77.62	$89.13	$147.91