Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $141.25 / $229.09	Facility	26	$74.13	$141.25	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $112.20 / $239.88	Professional		$77.62	$112.20	$239.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $74.13 / $245.47	Professional	26	$57.54	$74.13	$245.47
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $138.04 / $138.04	Professional	26	$138.04	$138.04	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $194.98 / $295.12	Professional		$117.49	$194.98	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $134.90 / $204.17	Professional	26	$83.18	$134.90	$204.17
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $134.90 / $169.82	Facility	26	$81.28	$134.90	$169.82
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $194.98 / $239.88	Professional		$114.82	$194.98	$239.88
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $134.90 / $169.82	Professional	26	$81.28	$134.90	$169.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $42.66	Professional		$32.36	$33.11	$42.66
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $128.82 / $134.90	Facility	26	$107.15	$128.82	$134.90
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $117.49 / $134.90	Professional	26	$77.62	$117.49	$134.90
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $89.13 / $89.13 / $91.20	Facility	26	$89.13	$89.13	$91.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $213.80 / $275.42	Professional		$128.82	$213.80	$275.42
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $151.36 / $194.98	Professional	26	$91.20	$151.36	$194.98
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $186.21 / $263.03	Professional		$125.89	$186.21	$263.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $131.83 / $173.78	Professional	26	$89.13	$131.83	$173.78
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $100.00 / $257.04	Professional		$91.20	$100.00	$257.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $69.18 / $169.82	Professional	26	$66.07	$69.18	$169.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $134.90 / $190.55	Professional		$100.00	$134.90	$190.55
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $93.33 / $131.83	Professional	26	$69.18	$93.33	$131.83