Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $67.08 / $261.36 / $319.20	Facility		$67.08	$261.36	$319.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $15.68 / $18.67 / $19.01	Facility	26	$15.68	$18.67	$19.01
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $48.39 / $79.64 / $283.20	Facility	TC	$48.39	$79.64	$283.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.62 / $37.74 / $67.08	Professional		$24.62	$37.74	$67.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.71 / $10.15 / $18.67	Professional	26	$6.71	$10.15	$18.67
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $76.58 / $76.58 / $94.79	Professional	50	$76.58	$76.58	$94.79
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $13.65 / $17.04 / $28.19	Professional	52	$13.65	$17.04	$28.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $23.27 / $42.70	Professional	TC	$17.89	$23.27	$42.70
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 $26.23 / $43.80 / $51.53	Professional		$26.23	$43.80	$51.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.55 / $12.34 / $14.52	Professional	26	$8.55	$12.34	$14.52
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.13 / $35.13 / $35.13	Professional	50	$35.13	$35.13	$35.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.68 / $31.46 / $37.01	Professional	TC	$17.68	$31.46	$37.01
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $51.49 / $67.80	Professional		$51.49	$51.49	$67.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.39 / $72.39 / $73.97	Professional	26	$72.39	$72.39	$73.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.39 / $72.39 / $73.97	Professional	TC	$72.39	$72.39	$73.97
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $28.23 / $51.19 / $64.83	Facility		$28.23	$51.19	$64.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.36 / $52.23 / $61.03	Professional		$45.36	$52.23	$61.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $13.53 / $15.81	Professional	26	$11.75	$13.53	$15.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.63 / $38.72 / $48.11	Professional	TC	$33.63	$38.72	$48.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $11.88 / $32.34 / $44.01	Professional		$11.88	$32.34	$44.01
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 $50.07 / $58.91 / $66.05	Professional		$50.07	$58.91	$66.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $15.07 / $18.00	Professional	26	$12.81	$15.07	$18.00
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $37.26 / $43.84 / $48.05	Professional	TC	$37.26	$43.84	$48.05
United Facility/Professional Professional Modifier Low / Median / High Price $27.91 / $29.56 / $53.04	Professional		$27.91	$29.56	$53.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.49 / $8.36 / $15.80	Professional	26	$7.49	$8.36	$15.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $20.21 / $21.28 / $38.40	Professional	TC	$20.21	$21.28	$38.40