Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $93.33 / $257.04	Facility	26	$57.54	$93.33	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $85.11 / $173.78	Professional		$64.57	$85.11	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $48.98 / $123.03	Professional	26	$38.02	$48.98	$123.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $165.96 / $165.96	Professional		$165.96	$165.96	$165.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $120.23 / $257.04	Professional		$77.62	$120.23	$257.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $69.18 / $138.04	Professional	26	$45.71	$69.18	$138.04
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $54.95 / $102.33	Facility	26	$39.81	$54.95	$102.33
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $81.28 / $165.96	Professional		$58.88	$81.28	$165.96
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $53.70 / $93.33	Professional	26	$38.90	$53.70	$93.33
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $32.36 / $33.11	Professional		$25.70	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $81.28 / $83.18	Facility	26	$66.07	$81.28	$83.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $91.20	Professional	26	$52.48	$66.07	$91.20
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $54.95 / $54.95 / $56.23	Facility	26	$54.95	$54.95	$56.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $154.88 / $218.78	Professional		$102.33	$154.88	$218.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $117.49	Professional	26	$54.95	$81.28	$117.49
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $72.44 / $72.44 / $72.44	Facility	26	$72.44	$72.44	$72.44
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $138.04 / $199.53	Professional		$104.71	$138.04	$199.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $77.62 / $107.15	Professional	26	$57.54	$77.62	$107.15
United Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $107.15 / $199.53	Professional		$75.86	$107.15	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $66.07 / $117.49	Professional	26	$46.77	$66.07	$117.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $87.10 / $147.91	Professional		$77.62	$87.10	$147.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $44.67 / $79.43	Professional	26	$41.69	$44.67	$79.43