Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.65 / $286.89 / $418.30	Facility		$87.65	$286.89	$418.30
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.18 / $21.14 / $21.56	Facility	26	$12.18	$21.14	$21.56
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $58.68 / $272.70 / $475.20	Facility	TC	$58.68	$272.70	$475.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.30 / $48.01 / $115.81	Professional		$24.30	$48.01	$115.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.61 / $12.99 / $33.24	Professional	26	$7.61	$12.99	$33.24
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $55.80 / $112.99 / $112.99	Professional	50	$55.80	$112.99	$112.99
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.32 / $22.11 / $36.83	Professional	52	$16.32	$22.11	$36.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.96 / $45.81 / $66.50	Professional	TC	$23.96	$45.81	$66.50
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 / $56.36 / $66.30	Professional		$30.95	$56.36	$66.30
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 $22.53 / $40.90 / $49.05	Professional	TC	$22.53	$40.90	$49.05
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $110.35 / $110.35 / $170.22	Professional		$110.35	$110.35	$170.22
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.44 / $58.44 / $58.56	Professional	26	$58.44	$58.44	$58.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.79 / $51.79 / $111.78	Professional	TC	$51.79	$51.79	$111.78
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.86 / $64.81 / $226.38	Facility		$32.86	$64.81	$226.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $51.62 / $61.71 / $78.28	Professional		$51.62	$61.71	$78.28
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 $44.83 / $47.55 / $54.34	Professional	TC	$44.83	$47.55	$54.34
Molina Facility/Professional Professional Modifier Low / Median / High Price $13.48 / $32.34 / $62.85	Professional		$13.48	$32.34	$62.85
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 $64.05 / $75.34 / $86.13	Professional		$64.05	$75.34	$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 $49.50 / $58.23 / $65.73	Professional	TC	$49.50	$58.23	$65.73
United Facility/Professional Professional Modifier Low / Median / High Price $32.93 / $37.24 / $70.23	Professional		$32.93	$37.24	$70.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $9.50 / $17.95	Professional	26	$8.51	$9.50	$17.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.74 / $27.74 / $49.64	Professional	TC	$23.74	$27.74	$49.64