Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $141.25 / $302.00	Professional		$69.18	$141.25	$302.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $38.90 / $512.86	Professional	26	$15.85	$38.90	$512.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $13.80 / $13.80	Professional	26	$13.80	$13.80	$13.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $131.83 / $177.83	Professional		$45.71	$131.83	$177.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $26.92 / $38.02	Professional	26	$14.13	$26.92	$38.02
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $37.15 / $63.10 / $3,630.78	Facility	26	$37.15	$63.10	$3,630.78
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $208.93 / $398.11	Professional		$123.03	$208.93	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $53.70 / $72.44	Professional	26	$37.15	$53.70	$72.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $74.13	Professional		$32.36	$33.11	$74.13
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $51.29 / $52.48	Facility	26	$38.90	$51.29	$52.48
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $46.77 / $58.88	Professional	26	$35.48	$46.77	$58.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $295.12 / $371.54	Professional		$186.21	$295.12	$371.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $58.88 / $72.44	Professional	26	$36.31	$58.88	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $239.88 / $316.23	Professional		$141.25	$239.88	$316.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $47.86 / $60.26	Professional	26	$36.31	$47.86	$60.26
United Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $114.82 / $234.42	Professional		$67.61	$114.82	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $25.12 / $57.54	Professional	26	$15.85	$25.12	$57.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $138.04	Professional		$138.04	$138.04	$138.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $25.70	Professional	26	$25.70	$25.70	$25.70