Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $6.92 / $21.88 / $91.20	Facility		$6.92	$21.88	$91.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $85.11 / $229.09	Facility	26	$36.31	$85.11	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $16.98 / $44.67 / $138.04	Professional		$16.98	$44.67	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $46.77 / $109.65	Professional	26	$17.38	$46.77	$109.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.12 / $25.12	Professional	26	$25.12	$25.12	$25.12
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3.39 / $7.59 / $27.54	Facility		$3.39	$7.59	$27.54
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.71 / $9.33 / $16.98	Facility	26	$8.71	$9.33	$16.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $43.65 / $43.65	Professional		$43.65	$43.65	$43.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $40.74 / $40.74	Professional	26	$40.74	$40.74	$40.74
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $28.18 / $75.86 / $123.03	Facility		$28.18	$75.86	$123.03
Kaiser Permanente Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $42.66 / $117.49	Facility	26	$26.30	$42.66	$117.49
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $93.33 / $134.90	Professional		$28.18	$93.33	$134.90
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $45.71 / $120.23	Professional	26	$26.30	$45.71	$120.23
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $32.36 / $33.11	Professional		$32.36	$32.36	$33.11
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $69.18 / $97.72 / $97.72	Facility		$69.18	$97.72	$97.72
Pacific Source Facility/Professional Facility Modifier 26 Low / Median / High Price $29.51 / $89.13 / $91.20	Facility	26	$29.51	$89.13	$91.20
Pacific Source Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $36.31 / $91.20	Professional	26	$23.99	$36.31	$91.20
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $64.57 / $64.57 / $67.61	Facility		$64.57	$64.57	$67.61
Premera BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $60.26 / $63.10	Facility	26	$60.26	$60.26	$63.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $112.20 / $141.25	Professional		$67.61	$112.20	$141.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $102.33 / $131.83	Professional	26	$63.10	$102.33	$131.83
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $83.18 / $120.23	Professional		$39.81	$83.18	$120.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $75.86 / $112.20	Professional	26	$33.88	$75.86	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $19.05 / $31.62 / $138.04	Professional		$19.05	$31.62	$138.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $31.62 / $128.82	Professional	26	$19.05	$31.62	$128.82
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $64.57 / $91.20	Professional		$47.86	$64.57	$91.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $85.11	Professional	26	$44.67	$60.26	$85.11