Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $84.36 / $266.70 / $510.02	Facility		$84.36	$266.70	$510.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.19 / $22.83 / $23.30	Facility	26	$13.19	$22.83	$23.30
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $62.50 / $255.64 / $428.89	Facility	TC	$62.50	$255.64	$428.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.00 / $63.23 / $139.08	Professional		$33.00	$63.23	$139.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $14.07 / $41.90	Professional	26	$8.56	$14.07	$41.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $17.34 / $62.88 / $131.05	Professional	50	$17.34	$62.88	$131.05
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.45 / $24.42 / $40.85	Professional	52	$18.45	$24.42	$40.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $38.52 / $71.26	Professional	TC	$24.44	$38.52	$71.26
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 $34.27 / $62.15 / $73.12	Professional		$34.27	$62.15	$73.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.47 / $15.09 / $17.75	Professional	26	$10.47	$15.09	$17.75
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $48.26 / $48.26 / $48.26	Professional	50	$48.26	$48.26	$48.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.06 / $46.26 / $55.37	Professional	TC	$26.06	$46.26	$55.37
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $124.31 / $124.31 / $158.22	Professional		$124.31	$124.31	$158.22
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.49 / $60.49 / $60.61	Professional	26	$60.49	$60.49	$60.61
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.70 / $63.70 / $97.73	Professional	TC	$63.70	$63.70	$97.73
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.64 / $70.29 / $126.17	Facility		$35.64	$70.29	$126.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $65.11 / $74.97 / $87.60	Professional		$65.11	$74.97	$87.60
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.40 / $15.28 / $18.96	Professional	26	$14.40	$15.28	$18.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.70 / $53.78 / $61.46	Professional	TC	$50.70	$53.78	$61.46
Molina Facility/Professional Professional Modifier Low / Median / High Price $14.56 / $32.34 / $63.14	Professional		$14.56	$32.34	$63.14
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $156.94 / $216.45 / $323.07	Facility		$156.94	$216.45	$323.07
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 $71.62 / $84.26 / $94.68	Professional		$71.62	$84.26	$94.68
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $15.73 / $18.50 / $22.03	Professional	26	$15.73	$18.50	$22.03
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $55.90 / $65.76 / $72.65	Professional	TC	$55.90	$65.76	$72.65
United Facility/Professional Professional Modifier Low / Median / High Price $38.11 / $41.80 / $79.40	Professional		$38.11	$41.80	$79.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.74 / $10.26 / $18.55	Professional	26	$9.74	$10.26	$18.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.25 / $31.54 / $56.45	Professional	TC	$28.25	$31.54	$56.45