Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.58 / $244.58 / $246.63	Facility	26	$93.58	$244.58	$246.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.99 / $522.50 / $983.25	Professional		$269.99	$522.50	$983.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.00 / $140.00 / $234.30	Professional	26	$73.00	$140.00	$234.30
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,218.00 / $1,218.00 / $1,218.00	Professional	50	$1,218.00	$1,218.00	$1,218.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $135.00 / $301.50 / $320.41	Professional	52	$135.00	$301.50	$320.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $196.88 / $335.00 / $499.00	Professional	TC	$196.88	$335.00	$499.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $174.46 / $194.99 / $521.34	Professional		$174.46	$194.99	$521.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.05 / $60.40 / $122.40	Professional	26	$54.05	$60.40	$122.40
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $301.29	Professional	50	$301.29	$301.29	$301.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.42 / $134.58 / $403.78	Professional	TC	$120.42	$134.58	$403.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,432.77 / $1,432.77 / $1,972.67	Professional		$1,432.77	$1,432.77	$1,972.67
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $283.19 / $283.19 / $532.19	Professional	26	$283.19	$283.19	$532.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $900.58 / $900.58 / $1,689.48	Professional	TC	$900.58	$900.58	$1,689.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $330.91 / $381.05 / $494.85	Professional		$330.91	$381.05	$494.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.94 / $117.38 / $137.15	Professional	26	$101.94	$117.38	$137.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $228.97 / $263.66 / $308.07	Professional	TC	$228.97	$263.66	$308.07
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $103.69 / $286.45	Professional		$32.34	$103.69	$286.45
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 $364.49 / $428.81 / $494.85	Professional		$364.49	$428.81	$494.85
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $111.21 / $130.84 / $158.09	Professional	26	$111.21	$130.84	$158.09
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $253.27 / $297.97 / $336.75	Professional	TC	$253.27	$297.97	$336.75
United Facility/Professional Professional Modifier Low / Median / High Price $198.48 / $387.11 / $776.04	Professional		$198.48	$387.11	$776.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.00 / $74.09 / $132.59	Professional	26	$57.00	$74.09	$132.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.66 / $251.15 / $462.38	Professional	TC	$138.66	$251.15	$462.38