Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $180.60 / $247.50 / $300.95	Facility		$180.60	$247.50	$300.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.10 / $81.43 / $85.53	Facility	26	$47.10	$81.43	$85.53
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.64 / $94.71 / $239.35	Professional		$59.64	$94.71	$239.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.44 / $36.79 / $81.43	Professional	26	$30.44	$36.79	$81.43
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $115.80 / $189.99 / $663.00	Professional	50	$115.80	$189.99	$663.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.41 / $58.24 / $104.19	Professional	TC	$47.41	$58.24	$104.19
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 $86.16 / $129.22 / $165.56	Professional		$86.16	$129.22	$165.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.58 / $50.60 / $64.70	Professional	26	$34.58	$50.60	$64.70
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.58 / $78.08 / $97.83	Professional	TC	$51.58	$78.08	$97.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $181.99 / $181.99 / $316.81	Professional		$181.99	$181.99	$316.81
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $154.82 / $154.82 / $155.13	Professional	26	$154.82	$154.82	$155.13
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.17 / $27.17 / $161.68	Professional	TC	$27.17	$27.17	$161.68
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $72.78 / $172.62 / $264.00	Facility		$72.78	$172.62	$264.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $135.56 / $147.88 / $182.40	Professional		$135.56	$147.88	$182.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.78 / $54.92 / $62.76	Professional	26	$51.78	$54.92	$62.76
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $114.08 / $114.08 / $114.08	Professional	50	$114.08	$114.08	$114.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.79 / $88.87 / $101.56	Professional	TC	$83.79	$88.87	$101.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $58.36 / $148.01	Professional		$32.34	$58.36	$148.01
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $156.94 / $217.32 / $319.48	Facility		$156.94	$217.32	$319.48
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 Professional Modifier Low / Median / High Price $148.47 / $174.68 / $201.14	Professional		$148.47	$174.68	$201.14
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $65.76 / $79.28	Professional	26	$55.90	$65.76	$79.28
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $92.58 / $108.92 / $121.86	Professional	TC	$92.58	$108.92	$121.86
United Facility/Professional Professional Modifier Low / Median / High Price $85.77 / $93.37 / $167.96	Professional		$85.77	$93.37	$167.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.36 / $36.49 / $65.29	Professional	26	$33.36	$36.49	$65.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.41 / $57.37 / $102.67	Professional	TC	$52.41	$57.37	$102.67