Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $178.75 / $178.75 / $178.75	Facility	26	$178.75	$178.75	$178.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $357.91 / $492.57 / $890.16	Professional		$357.91	$492.57	$890.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.01 / $140.00 / $254.90	Professional	26	$78.01	$140.00	$254.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.41 / $348.53 / $670.24	Professional	TC	$281.41	$348.53	$670.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $298.94 / $334.11 / $755.96	Professional		$298.94	$334.11	$755.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.83 / $64.63 / $130.86	Professional	26	$57.83	$64.63	$130.86
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $241.11 / $269.47 / $632.14	Professional	TC	$241.11	$269.47	$632.14
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,431.42 / $1,431.42 / $1,589.01	Professional		$1,431.42	$1,431.42	$1,589.01
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $428.69 / $428.69 / $566.99	Professional	26	$428.69	$428.69	$566.99
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,002.73 / $1,002.73 / $1,022.02	Professional	TC	$1,002.73	$1,002.73	$1,022.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $543.86 / $626.26 / $826.07	Professional		$543.86	$626.26	$826.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.94 / $126.60 / $147.91	Professional	26	$109.94	$126.60	$147.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $433.92 / $499.66 / $583.82	Professional	TC	$433.92	$499.66	$583.82
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $124.49 / $495.41	Professional		$32.34	$124.49	$495.41
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $446.45	Facility	26	$446.45	$446.45	$446.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $575.65 / $714.46 / $826.07	Professional		$575.65	$714.46	$826.07
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $119.36 / $140.41 / $169.48	Professional	26	$119.36	$140.41	$169.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $487.93 / $574.03 / $656.59	Professional	TC	$487.93	$574.03	$656.59
United Facility/Professional Professional Modifier Low / Median / High Price $342.35 / $453.94 / $910.02	Professional		$342.35	$453.94	$910.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.18 / $79.05 / $141.44	Professional	26	$60.18	$79.05	$141.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $278.54 / $393.76 / $813.75	Professional	TC	$278.54	$393.76	$813.75