Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $253.60 / $574.64 / $648.96	Facility		$253.60	$574.64	$648.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.48 / $88.39 / $89.13	Facility	26	$50.48	$88.39	$89.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $130.13 / $238.24 / $450.30	Facility	TC	$130.13	$238.24	$450.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.95 / $143.07 / $242.48	Professional		$100.95	$143.07	$242.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $50.48 / $131.93	Professional	26	$31.67	$50.48	$131.93
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.94 / $59.82 / $110.74	Professional	52	$35.94	$59.82	$110.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.06 / $99.56 / $147.19	Professional	TC	$67.06	$99.56	$147.19
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 $109.11 / $170.89 / $232.40	Professional		$109.11	$170.89	$232.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.07 / $54.68 / $70.43	Professional	26	$37.07	$54.68	$70.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.05 / $116.20 / $168.51	Professional	TC	$72.05	$116.20	$168.51
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $275.80 / $275.80 / $322.74	Professional		$275.80	$275.80	$322.74
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $164.90 / $164.90 / $168.49	Professional	26	$164.90	$164.90	$168.49
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.90 / $110.90 / $154.25	Professional	TC	$110.90	$110.90	$154.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $100.78 / $221.48 / $316.72	Facility		$100.78	$221.48	$316.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $172.39 / $193.29 / $241.74	Professional		$172.39	$193.29	$241.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.51 / $58.87 / $67.28	Professional	26	$55.51	$58.87	$67.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.89 / $123.97 / $141.68	Professional	TC	$116.89	$123.97	$141.68
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $62.73 / $187.59	Professional		$32.34	$62.73	$187.59
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 Facility Modifier TC Low / Median / High Price $211.40 / $211.40 / $211.40	Facility	TC	$211.40	$211.40	$211.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $189.24 / $222.63 / $256.27	Professional		$189.24	$222.63	$256.27
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.55 / $71.23 / $85.22	Professional	26	$60.55	$71.23	$85.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $128.68 / $151.38 / $171.07	Professional	TC	$128.68	$151.38	$171.07
United Facility/Professional Professional Modifier Low / Median / High Price $115.13 / $136.15 / $252.00	Professional		$115.13	$136.15	$252.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.08 / $39.52 / $70.72	Professional	26	$36.08	$39.52	$70.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.59 / $100.07 / $189.92	Professional	TC	$77.59	$100.07	$189.92