Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $144.54 / $234.42	Facility	26	$72.44	$144.54	$234.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $380.19 / $1,096.48	Professional		$295.12	$380.19	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $162.18	Professional	26	$51.29	$67.61	$162.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $112.20	Professional	26	$112.20	$112.20	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $741.31 / $1,096.48	Professional		$446.68	$741.31	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.90 / $213.80	Professional	26	$87.10	$134.90	$213.80
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $162.18 / $2,344.23	Facility	26	$102.33	$162.18	$2,344.23
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $831.76 / $1,096.48	Professional		$575.44	$831.76	$1,096.48
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $147.91 / $181.97	Professional	26	$102.33	$147.91	$181.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $125.89 / $131.83	Facility	26	$104.71	$125.89	$131.83
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $114.82 / $138.04	Professional	26	$81.28	$114.82	$138.04
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $87.10 / $87.10 / $87.10	Facility	26	$87.10	$87.10	$87.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $794.33 / $954.99	Professional		$467.74	$794.33	$954.99
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $147.91 / $186.21	Professional	26	$87.10	$147.91	$186.21
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	26	$954.99	$954.99	$954.99
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $741.31 / $1,000.00	Professional		$478.63	$741.31	$1,000.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $138.04 / $186.21	Professional	26	$89.13	$138.04	$186.21
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $371.54 / $977.24	Professional		$269.15	$371.54	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $69.18 / $186.21	Professional	26	$57.54	$69.18	$186.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $457.09 / $645.65	Professional		$389.05	$457.09	$645.65
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $87.10 / $120.23	Professional	26	$74.13	$87.10	$120.23