Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $47.86 / $123.03	Facility	26	$28.84	$47.86	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $144.54 / $316.23	Professional		$117.49	$144.54	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $24.55 / $47.86	Professional	26	$20.89	$24.55	$47.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $251.19 / $407.38	Professional		$251.19	$251.19	$407.38
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $5.62 / $26.30 / $37.15	Facility	26	$5.62	$26.30	$37.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $251.19 / $478.63	Professional		$154.88	$251.19	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.02 / $72.44	Professional	26	$25.12	$38.02	$72.44
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $44.67 / $323.59	Facility	26	$27.54	$44.67	$323.59
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $257.04 / $398.11	Professional		$134.90	$257.04	$398.11
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $43.65 / $58.88	Professional	26	$27.54	$43.65	$58.88
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 $37.15 / $43.65 / $47.86	Facility	26	$37.15	$43.65	$47.86
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $37.15 / $43.65	Professional	26	$26.30	$37.15	$43.65
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $31.62 / $31.62 / $32.36	Facility	26	$31.62	$31.62	$32.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $316.23 / $416.87	Professional		$199.53	$316.23	$416.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $50.12 / $67.61	Professional	26	$31.62	$50.12	$67.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $371.54	Professional		$208.93	$295.12	$371.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $45.71 / $58.88	Professional	26	$33.11	$45.71	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $229.09 / $389.05	Professional		$158.49	$229.09	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $37.15 / $64.57	Professional	26	$25.70	$37.15	$64.57
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $154.88 / $257.04	Professional		$134.90	$154.88	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $26.30 / $43.65	Professional	26	$22.91	$26.30	$43.65