Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $269.43 / $426.80 / $519.29	Facility		$269.43	$426.80	$519.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.27 / $68.30 / $68.87	Facility	26	$39.27	$68.30	$68.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.94 / $141.74 / $262.83	Professional		$102.94	$141.74	$262.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $36.96 / $100.25	Professional	26	$24.07	$36.96	$100.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.09 / $53.68 / $113.21	Professional	52	$37.09	$53.68	$113.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.45 / $95.46 / $169.03	Professional	TC	$76.45	$95.46	$169.03
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 $106.88 / $170.01 / $219.84	Professional		$106.88	$170.01	$219.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.90 / $41.54 / $53.09	Professional	26	$27.90	$41.54	$53.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.01 / $127.53 / $163.40	Professional	TC	$81.01	$127.53	$163.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $238.35 / $238.35 / $340.86	Professional		$238.35	$238.35	$340.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.33 / $135.33 / $135.33	Professional	26	$135.33	$135.33	$135.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $103.02 / $103.02 / $205.53	Professional	TC	$103.02	$103.02	$205.53
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $94.98 / $200.84 / $356.00	Facility		$94.98	$200.84	$356.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $175.07 / $195.92 / $235.06	Professional		$175.07	$195.92	$235.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.70 / $45.29 / $51.76	Professional	26	$42.70	$45.29	$51.76
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.36 / $140.38 / $160.44	Professional	TC	$132.36	$140.38	$160.44
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $48.22 / $189.70	Professional		$32.34	$48.22	$189.70
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $211.40 / $288.06 / $458.49	Facility		$211.40	$288.06	$458.49
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 $192.73 / $226.74 / $260.77	Professional		$192.73	$226.74	$260.77
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $54.12 / $65.87	Professional	26	$46.00	$54.12	$65.87
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $146.72 / $172.62 / $194.90	Professional	TC	$146.72	$172.62	$194.90
United Facility/Professional Professional Modifier Low / Median / High Price $118.01 / $123.22 / $228.07	Professional		$118.01	$123.22	$228.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.23 / $30.40 / $54.40	Professional	26	$27.23	$30.40	$54.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.14 / $95.99 / $172.59	Professional	TC	$89.14	$95.99	$172.59