Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.95 / $136.06 / $137.19	Facility	26	$73.95	$136.06	$137.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.40 / $176.62 / $303.70	Professional		$134.40	$176.62	$303.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $57.78 / $115.51	Professional	26	$46.10	$57.78	$115.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $88.29 / $118.84 / $189.37	Professional	TC	$88.29	$118.84	$189.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.49 / $129.07 / $264.77	Professional		$115.49	$129.07	$264.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.79 / $47.83 / $96.37	Professional	26	$42.79	$47.83	$96.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.69 / $81.25 / $166.75	Professional	TC	$72.69	$81.25	$166.75
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $433.56 / $433.56 / $617.13	Professional		$433.56	$433.56	$617.13
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $245.04 / $245.04 / $245.04	Professional	26	$245.04	$245.04	$245.04
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $372.09 / $372.09 / $372.09	Professional	TC	$372.09	$372.09	$372.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $223.62 / $257.51 / $335.52	Professional		$223.62	$257.51	$335.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.13 / $86.05 / $98.34	Professional	26	$81.13	$86.05	$98.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $142.51 / $151.15 / $172.74	Professional	TC	$142.51	$151.15	$172.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $82.48 / $244.26	Professional		$32.34	$82.48	$244.26
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $156.94 / $156.94 / $156.94	Facility	26	$156.94	$156.94	$156.94
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $246.30 / $289.76 / $335.52	Professional		$246.30	$289.76	$335.52
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $88.50 / $104.12 / $125.24	Professional	26	$88.50	$104.12	$125.24
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $157.79 / $185.64 / $210.28	Professional	TC	$157.79	$185.64	$210.28
United Facility/Professional Professional Modifier Low / Median / High Price $126.72 / $165.97 / $297.83	Professional		$126.72	$165.97	$297.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.69 / $57.39 / $102.69	Professional	26	$43.69	$57.39	$102.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.03 / $103.57 / $195.15	Professional	TC	$83.03	$103.57	$195.15