Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.42 / $275.39 / $558.05	Facility		$74.42	$275.39	$558.05
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.18 / $21.14 / $22.21	Facility	26	$12.18	$21.14	$22.21
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $55.22 / $240.58 / $555.20	Facility	TC	$55.22	$240.58	$555.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.96 / $47.00 / $114.57	Professional		$28.96	$47.00	$114.57
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.50 / $12.99 / $36.70	Professional	26	$7.50	$12.99	$36.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $57.92 / $111.78 / $114.57	Professional	50	$57.92	$111.78	$114.57
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.67 / $44.33 / $65.72	Professional	TC	$23.67	$44.33	$65.72
Cigna Facility/Professional Facility Modifier Low / Median / High Price $110.60 / $273.04 / $498.63	Facility		$110.60	$273.04	$498.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $30.95 / $55.84 / $65.69	Professional		$30.95	$55.84	$65.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $13.97 / $16.44	Professional	26	$9.31	$13.97	$16.44
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $43.28 / $43.28 / $43.28	Professional	50	$43.28	$43.28	$43.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.89 / $40.90 / $49.25	Professional	TC	$22.89	$40.90	$49.25
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $109.70 / $109.70 / $137.75	Professional		$109.70	$109.70	$137.75
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.37 / $47.37 / $58.56	Professional	26	$47.37	$47.37	$58.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.14 / $51.14 / $90.38	Professional	TC	$51.14	$51.14	$90.38
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.86 / $63.90 / $226.40	Facility		$32.86	$63.90	$226.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $59.78 / $68.25 / $80.43	Professional		$59.78	$68.25	$80.43
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $13.35 / $15.37 / $17.96	Professional	26	$13.35	$15.37	$17.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.43 / $49.25 / $56.28	Professional	TC	$46.43	$49.25	$56.28
Molina Facility/Professional Professional Modifier Low / Median / High Price $15.02 / $32.34 / $64.56	Professional		$15.02	$32.34	$64.56
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $134.19 / $206.06 / $311.69	Facility		$134.19	$206.06	$311.69
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 Facility Modifier TC Low / Median / High Price $156.94 / $156.94 / $156.94	Facility	TC	$156.94	$156.94	$156.94
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $65.20 / $76.72 / $86.13	Professional		$65.20	$76.72	$86.13
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $14.56 / $17.13 / $20.39	Professional	26	$14.56	$17.13	$20.39
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $50.66 / $59.60 / $65.73	Professional	TC	$50.66	$59.60	$65.73
United Facility/Professional Professional Modifier Low / Median / High Price $32.93 / $35.36 / $66.64	Professional		$32.93	$35.36	$66.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.50 / $17.27	Professional	26	$8.51	$9.50	$17.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.47 / $26.35 / $49.64	Professional	TC	$23.47	$26.35	$49.64