Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.27 / $153.36 / $153.36	Facility	26	$83.27	$153.36	$153.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $219.17 / $340.04 / $373.85	Professional		$219.17	$340.04	$373.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.46 / $65.06 / $128.88	Professional	26	$52.46	$65.06	$128.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $154.11 / $244.97 / $285.86	Professional	TC	$154.11	$244.97	$285.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $142.53 / $159.30 / $416.55	Professional		$142.53	$159.30	$416.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.25 / $53.92 / $109.88	Professional	26	$48.25	$53.92	$109.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.28 / $105.38 / $311.70	Professional	TC	$94.28	$105.38	$311.70
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,057.35 / $1,057.35 / $1,196.61	Professional		$1,057.35	$1,057.35	$1,196.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $462.40 / $462.40 / $518.27	Professional	26	$462.40	$462.40	$518.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $539.09 / $539.09 / $734.22	Professional	TC	$539.09	$539.09	$734.22
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $273.80 / $315.29 / $411.00	Professional		$273.80	$315.29	$411.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $91.26 / $105.09 / $122.79	Professional	26	$91.26	$105.09	$122.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $182.54 / $210.20 / $245.60	Professional	TC	$182.54	$210.20	$245.60
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $92.98 / $237.60	Professional		$32.34	$92.98	$237.60
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $714.15 / $714.15 / $714.15	Facility	26	$714.15	$714.15	$714.15
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $302.19 / $355.52 / $411.00	Professional		$302.19	$355.52	$411.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $99.57 / $117.14 / $141.13	Professional	26	$99.57	$117.14	$141.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $202.62 / $238.38 / $269.86	Professional	TC	$202.62	$238.38	$269.86
United Facility/Professional Professional Modifier Low / Median / High Price $168.72 / $249.10 / $539.38	Professional		$168.72	$249.10	$539.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.63 / $62.44 / $124.14	Professional	26	$50.63	$62.44	$124.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.64 / $198.47 / $413.56	Professional	TC	$115.64	$198.47	$413.56