Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $575.44 / $891.25	Facility	26	$446.68	$575.44	$891.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,348.96 / $2,398.83	Professional		$1,071.52	$1,348.96	$2,398.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $436.52 / $1,412.54	Professional	26	$323.59	$436.52	$1,412.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $512.86 / $575.44 / $645.65	Professional	26	$512.86	$575.44	$645.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $2,137.96 / $3,548.13	Professional		$1,380.38	$2,137.96	$3,548.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $416.87 / $602.56 / $954.99	Professional	26	$416.87	$602.56	$954.99
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $741.31 / $13,803.84	Facility	26	$512.86	$741.31	$13,803.84
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $1,698.24 / $2,454.71 / $3,630.78	Professional		$1,698.24	$2,454.71	$3,630.78
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $407.38 / $691.83 / $912.01	Professional	26	$407.38	$691.83	$912.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $75.86	Professional		$32.36	$33.11	$75.86
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $537.03 / $616.60 / $660.69	Facility	26	$537.03	$616.60	$660.69
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $602.56 / $707.95	Professional	26	$389.05	$602.56	$707.95
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,513.56 / $2,511.89 / $3,090.30	Professional		$1,513.56	$2,511.89	$3,090.30
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $724.44 / $954.99	Professional	26	$446.68	$724.44	$954.99
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,623.41 / $5,623.41 / $5,623.41	Facility	26	$5,623.41	$5,623.41	$5,623.41
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,584.89 / $2,137.96 / $2,951.21	Professional		$1,584.89	$2,137.96	$2,951.21
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $630.96 / $870.96	Professional	26	$446.68	$630.96	$870.96
United Facility/Professional Professional Modifier Low / Median / High Price $1,202.26 / $1,778.28 / $3,090.30	Professional		$1,202.26	$1,778.28	$3,090.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $537.03 / $912.01	Professional	26	$346.74	$537.03	$912.01
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $1,288.25 / $1,513.56 / $2,137.96	Professional		$1,288.25	$1,513.56	$2,137.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $371.54 / $436.52 / $616.60	Professional	26	$371.54	$436.52	$616.60