Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.28 / $115.28 / $115.28	Facility	26	$115.28	$115.28	$115.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.24 / $163.13 / $198.43	Professional		$109.24	$163.13	$198.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $40.79 / $96.88	Professional	26	$15.71	$40.79	$96.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.72 / $101.54 / $161.07	Professional	TC	$59.72	$101.54	$161.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.69 / $162.78 / $204.21	Professional		$102.69	$162.78	$204.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.27 / $67.22 / $87.33	Professional	26	$20.27	$67.22	$87.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.77 / $91.70 / $152.97	Professional	TC	$68.77	$91.70	$152.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $289.35 / $289.35 / $419.97	Professional		$289.35	$289.35	$419.97
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.08 / $72.08 / $298.58	Professional	26	$72.08	$72.08	$298.58
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $121.38 / $121.38 / $217.27	Professional	TC	$121.38	$121.38	$217.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $153.16 / $176.38 / $229.53	Professional		$153.16	$176.38	$229.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.58 / $76.98 / $87.98	Professional	26	$72.58	$76.98	$87.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $80.59 / $92.80 / $108.42	Professional	TC	$80.59	$92.80	$108.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $73.40 / $167.97	Professional		$32.34	$73.40	$167.97
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $168.27 / $197.97 / $229.53	Professional		$168.27	$197.97	$229.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $79.19 / $93.16 / $111.51	Professional	26	$79.19	$93.16	$111.51
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $89.09 / $104.81 / $118.02	Professional	TC	$89.09	$104.81	$118.02
United Facility/Professional Professional Modifier Low / Median / High Price $109.71 / $132.41 / $225.63	Professional		$109.71	$132.41	$225.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.70 / $49.80 / $79.68	Professional	26	$17.70	$49.80	$79.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.91 / $106.68 / $180.11	Professional	TC	$59.91	$106.68	$180.11