Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $73.36 / $110.87 / $343.20	Facility		$73.36	$110.87	$343.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.18 / $63.29 / $78.29	Facility	26	$44.18	$63.29	$78.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.32 / $90.20 / $172.37	Professional		$57.32	$90.20	$172.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.99 / $47.75 / $95.02	Professional	26	$28.99	$47.75	$95.02
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $82.23 / $165.74 / $179.00	Professional	50	$82.23	$165.74	$179.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.42 / $36.86 / $45.95	Professional	TC	$16.42	$36.86	$45.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $148.86 / $367.78 / $603.27	Facility		$148.86	$367.78	$603.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.01 / $83.80 / $132.97	Professional		$55.01	$83.80	$132.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.36 / $51.80 / $75.98	Professional	26	$35.36	$51.80	$75.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.64 / $30.05 / $57.74	Professional	TC	$19.64	$30.05	$57.74
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $162.32 / $162.32 / $234.96	Professional		$162.32	$162.32	$234.96
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $221.81 / $221.81 / $221.91	Professional	26	$221.81	$221.81	$221.91
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $13.15 / $13.15 / $221.91	Professional	TC	$13.15	$13.15	$221.91
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $45.41 / $105.21 / $216.16	Facility		$45.41	$105.21	$216.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $76.33 / $85.58 / $114.32	Professional		$76.33	$85.58	$114.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.03 / $52.40 / $85.58	Professional	26	$48.03	$52.40	$85.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.28 / $30.85 / $47.99	Professional	TC	$28.28	$30.85	$47.99
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.47 / $32.34 / $84.59	Professional		$25.47	$32.34	$84.59
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $211.40 / $273.07 / $398.05	Facility		$211.40	$273.07	$398.05
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $211.40	Facility	26	$211.40	$211.40	$211.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $83.84 / $98.64 / $114.33	Professional		$83.84	$98.64	$114.33
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $52.40 / $61.65 / $73.97	Professional	26	$52.40	$61.65	$73.97
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $31.44 / $36.99 / $40.36	Professional	TC	$31.44	$36.99	$40.36
United Facility/Professional Professional Modifier Low / Median / High Price $53.77 / $92.92 / $185.63	Professional		$53.77	$92.92	$185.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.11 / $52.42 / $99.49	Professional	26	$32.11	$52.42	$99.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $21.65 / $40.50 / $80.04	Professional	TC	$21.65	$40.50	$80.04