Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $365.67 / $365.67 / $365.67	Facility		$365.67	$365.67	$365.67
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $202.32 / $202.32 / $202.32	Facility	26	$202.32	$202.32	$202.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $158.96 / $235.93 / $321.86	Professional		$158.96	$235.93	$321.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $83.87 / $193.82	Professional	26	$48.86	$83.87	$193.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $70.36 / $117.97 / $153.65	Professional	52	$70.36	$117.97	$153.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $82.21 / $162.66 / $202.54	Professional	TC	$82.21	$162.66	$202.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $3,914.19 / $9,658.25 / $17,490.63	Facility		$3,914.19	$9,658.25	$17,490.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.85 / $247.86 / $321.77	Professional		$183.85	$247.86	$321.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.58 / $127.77 / $157.28	Professional	26	$68.58	$127.77	$157.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.31 / $120.89 / $195.19	Professional	TC	$85.31	$120.89	$195.19
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $765.67 / $765.67 / $849.97	Professional		$765.67	$765.67	$849.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $328.19 / $328.19 / $641.98	Professional	26	$328.19	$328.19	$641.98
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.69 / $123.69 / $521.78	Professional	TC	$123.69	$123.69	$521.78
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $153.15 / $368.75 / $867.03	Facility		$153.15	$368.75	$867.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $236.97 / $272.88 / $352.73	Professional		$236.97	$272.88	$352.73
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $129.16 / $136.99 / $156.56	Professional	26	$129.16	$136.99	$156.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.81 / $124.15 / $145.05	Professional	TC	$107.81	$124.15	$145.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $91.51 / $204.82	Professional		$32.34	$91.51	$204.82
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $5,184.85 / $7,592.53 / $10,933.24	Facility		$5,184.85	$7,592.53	$10,933.24
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $5,551.62 / $5,551.62 / $5,551.62	Facility	26	$5,551.62	$5,551.62	$5,551.62
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $262.01 / $308.25 / $352.73	Professional		$262.01	$308.25	$352.73
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $141.49 / $166.46 / $194.36	Professional	26	$141.49	$166.46	$194.36
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.52 / $141.79 / $158.37	Professional	TC	$120.52	$141.79	$158.37
United Facility/Professional Professional Modifier Low / Median / High Price $167.09 / $208.65 / $386.19	Professional		$167.09	$208.65	$386.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.80 / $88.42 / $141.47	Professional	26	$54.80	$88.42	$141.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.67 / $153.85 / $346.97	Professional	TC	$78.67	$153.85	$346.97