Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $74.94 / $315.00 / $380.45	Facility		$74.94	$315.00	$380.45
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.17 / $19.45 / $19.85	Facility	26	$11.17	$19.45	$19.85
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $53.10 / $277.60 / $566.40	Facility	TC	$53.10	$277.60	$566.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.22 / $38.70 / $76.28	Professional		$22.22	$38.70	$76.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $11.89 / $30.51	Professional	26	$7.33	$11.89	$30.51
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $112.62 / $112.62 / $259.50	Professional	50	$112.62	$112.62	$259.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.94 / $33.29 / $51.29	Professional	TC	$19.94	$33.29	$51.29
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 $26.99 / $48.48 / $57.04	Professional		$26.99	$48.48	$57.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.31 / $12.86 / $15.21	Professional	26	$9.31	$12.86	$15.21
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $38.29 / $38.29 / $38.29	Professional	50	$38.29	$38.29	$38.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.94 / $35.53 / $41.54	Professional	TC	$19.94	$35.53	$41.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $97.83 / $97.83 / $128.72	Professional		$97.83	$97.83	$128.72
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.19 / $41.19 / $53.42	Professional	26	$41.19	$41.19	$53.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.41 / $44.41 / $87.53	Professional	TC	$44.41	$44.41	$87.53
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $30.12 / $56.03 / $76.80	Facility		$30.12	$56.03	$76.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $50.70 / $53.78 / $68.22	Professional		$50.70	$53.78	$68.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.28 / $14.14 / $16.52	Professional	26	$12.28	$14.14	$16.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.43 / $40.76 / $46.58	Professional	TC	$38.43	$40.76	$46.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.41 / $32.34 / $49.16	Professional		$12.41	$32.34	$49.16
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 $55.32 / $65.08 / $73.73	Professional		$55.32	$65.08	$73.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $13.40 / $15.76 / $18.77	Professional	26	$13.40	$15.76	$18.77
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $41.92 / $49.32 / $54.97	Professional	TC	$41.92	$49.32	$54.97
United Facility/Professional Professional Modifier Low / Median / High Price $28.25 / $32.68 / $58.49	Professional		$28.25	$32.68	$58.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.30 / $8.74 / $15.87	Professional	26	$8.30	$8.74	$15.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.73 / $23.94 / $42.85	Professional	TC	$19.73	$23.94	$42.85