Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.28 / $151.36 / $245.47	Facility	26	$81.28	$151.36	$245.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $144.54 / $346.74	Professional	26	$75.86	$144.54	$346.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $213.80	Professional	26	$112.20	$112.20	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $223.87	Professional	26	$85.11	$141.25	$223.87
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $169.82 / $6,918.31	Facility	26	$107.15	$169.82	$6,918.31
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $154.88 / $190.55	Professional	26	$107.15	$154.88	$190.55
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $112.20 / $134.90 / $138.04	Facility	26	$112.20	$134.90	$138.04
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $120.23 / $154.88	Professional	26	$83.18	$120.23	$154.88
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $93.33 / $125.89	Facility	26	$93.33	$93.33	$125.89
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $154.88 / $199.53	Professional	26	$93.33	$154.88	$199.53
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Facility	26	$2,884.03	$2,884.03	$2,884.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $144.54 / $194.98	Professional	26	$104.71	$144.54	$194.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $75.86 / $194.98	Professional	26	$61.66	$75.86	$194.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $91.20 / $128.82	Professional	26	$77.62	$91.20	$128.82