Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.25 / $242.02 / $425.92	Facility		$69.25	$242.02	$425.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.62 / $27.21 / $27.44	Facility	26	$15.62	$27.21	$27.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $47.67 / $71.23 / $343.20	Facility	TC	$47.67	$71.23	$343.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $49.46 / $94.31	Professional		$35.95	$49.46	$94.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.36 / $12.21 / $27.21	Professional	26	$10.36	$12.21	$27.21
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	50	$38.29	$38.29	$38.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $33.83 / $63.65	Professional	TC	$25.57	$33.83	$63.65
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 $40.85 / $63.48 / $74.69	Professional		$40.85	$63.48	$74.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.69 / $17.98 / $21.15	Professional	26	$12.69	$17.98	$21.15
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $49.64 / $49.64 / $49.64	Professional	50	$49.64	$49.64	$49.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.11 / $45.07 / $53.08	Professional	TC	$28.11	$45.07	$53.08
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $96.52 / $96.52 / $144.49	Professional		$96.52	$96.52	$144.49
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.91 / $71.91 / $71.91	Professional	26	$71.91	$71.91	$71.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.58 / $72.58 / $72.58	Professional	TC	$72.58	$72.58	$72.58
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $38.34 / $82.73 / $99.28	Facility		$38.34	$82.73	$99.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $66.18 / $76.20 / $89.04	Professional		$66.18	$76.20	$89.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.07 / $18.11 / $20.70	Professional	26	$17.07	$18.11	$20.70
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $49.10 / $56.54 / $59.52	Professional	TC	$49.10	$56.54	$59.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $17.34 / $32.34 / $71.73	Professional		$17.34	$32.34	$71.73
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $203.90 / $261.88 / $385.48	Facility		$203.90	$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 $72.20 / $84.94 / $96.59	Professional		$72.20	$84.94	$96.59
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 $53.57 / $63.02 / $70.34	Professional	TC	$53.57	$63.02	$70.34
United Facility/Professional Professional Modifier Low / Median / High Price $37.78 / $40.42 / $76.16	Professional		$37.78	$40.42	$76.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.23 / $12.16 / $21.76	Professional	26	$11.23	$12.16	$21.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.55 / $30.40 / $54.40	Professional	TC	$26.55	$30.40	$54.40