Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $141.25 / $181.97	Facility	26	$85.11	$141.25	$181.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $173.78 / $346.74	Professional		$141.25	$173.78	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $85.11 / $288.40	Professional	26	$63.10	$85.11	$288.40
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $288.40	Professional		$288.40	$288.40	$288.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $117.49 / $138.04	Professional	26	$75.86	$117.49	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $257.04 / $467.74	Professional		$162.18	$257.04	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $109.65 / $199.53	Professional	26	$69.18	$109.65	$199.53
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $97.72 / $186.21	Facility	26	$63.10	$97.72	$186.21
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $223.87 / $389.05	Professional		$147.91	$223.87	$389.05
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $95.50 / $158.49	Professional	26	$61.66	$95.50	$158.49
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $83.18	Professional		$32.36	$33.11	$83.18
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $109.65 / $131.83 / $131.83	Facility	26	$109.65	$131.83	$131.83
Pacific Source Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $162.18	Professional		$162.18	$162.18	$162.18
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $114.82 / $144.54	Professional	26	$79.43	$114.82	$144.54
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $91.20 / $91.20	Facility	26	$91.20	$91.20	$91.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $309.03 / $457.09	Professional		$213.80	$309.03	$457.09
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $91.20 / $134.90 / $194.98	Professional	26	$91.20	$134.90	$194.98
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $512.86 / $512.86	Facility	26	$512.86	$512.86	$512.86
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $295.12 / $380.19	Professional		$213.80	$295.12	$380.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $125.89 / $165.96	Professional	26	$93.33	$125.89	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $223.87 / $389.05	Professional		$151.36	$223.87	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $100.00 / $173.78	Professional	26	$67.61	$100.00	$173.78
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $199.53 / $323.59	Professional		$169.82	$199.53	$323.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $79.43 / $131.83	Professional	26	$69.18	$79.43	$131.83