Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $81.79 / $336.27 / $415.42	Facility		$81.79	$336.27	$415.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.62 / $27.21 / $27.75	Facility	26	$15.62	$27.21	$27.75
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $48.36 / $181.80 / $407.55	Facility	TC	$48.36	$181.80	$407.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.24 / $55.47 / $95.29	Professional		$38.24	$55.47	$95.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $15.62 / $29.24	Professional	26	$10.02	$15.62	$29.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $45.50 / $65.20	Professional	TC	$26.62	$45.50	$65.20
Cigna Facility/Professional Facility Modifier Low / Median / High Price $148.86 / $367.78 / $603.27	Facility		$148.86	$367.78	$603.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $38.74 / $61.40 / $72.23	Professional		$38.74	$61.40	$72.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.42 / $17.98 / $21.15	Professional	26	$12.42	$17.98	$21.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.32 / $42.09 / $50.78	Professional	TC	$26.32	$42.09	$50.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $90.41 / $90.41 / $135.93	Professional		$90.41	$90.41	$135.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.78 / $61.78 / $79.97	Professional	26	$61.78	$61.78	$79.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $10.44 / $10.44 / $74.15	Professional	TC	$10.44	$10.44	$74.15
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $39.51 / $76.09 / $102.50	Facility		$39.51	$76.09	$102.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $63.51 / $73.13 / $93.51	Professional		$63.51	$73.13	$93.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $19.67 / $22.91	Professional	26	$17.07	$19.67	$22.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $49.77 / $56.28	Professional	TC	$46.43	$49.77	$56.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.34 / $32.34 / $61.81	Professional		$17.34	$32.34	$61.81
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $192.42 / $261.88 / $385.48	Facility		$192.42	$261.88	$385.48
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $211.40	Facility	26	$211.40	$211.40	$211.40
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $211.40 / $211.40 / $211.40	Facility	TC	$211.40	$211.40	$211.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $69.87 / $82.20 / $93.51	Professional		$69.87	$82.20	$93.51
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $18.63 / $21.92 / $26.24	Professional	26	$18.63	$21.92	$26.24
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $51.24 / $60.28 / $67.27	Professional	TC	$51.24	$60.28	$67.27
United Facility/Professional Professional Modifier Low / Median / High Price $37.78 / $40.65 / $74.95	Professional		$37.78	$40.65	$74.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.55 / $12.16 / $21.76	Professional	26	$11.55	$12.16	$21.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.38 / $27.07 / $51.01	Professional	TC	$24.38	$27.07	$51.01