Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.51 / $90.97 / $95.56	Facility	26	$52.51	$90.97	$95.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.73 / $157.12 / $258.70	Professional		$124.73	$157.12	$258.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.71 / $41.03 / $86.32	Professional	26	$32.71	$41.03	$86.32
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $119.66 / $170.88 / $212.90	Professional	52	$119.66	$170.88	$212.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $92.01 / $109.71 / $182.26	Professional	TC	$92.01	$109.71	$182.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.58 / $204.46 / $243.12	Professional		$141.58	$204.46	$243.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.78 / $60.64 / $71.34	Professional	26	$40.78	$60.64	$71.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $100.80 / $143.83 / $173.44	Professional	TC	$100.80	$143.83	$173.44
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $303.66 / $303.66 / $449.45	Professional		$303.66	$303.66	$449.45
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.44 / $139.44 / $160.27	Professional	26	$139.44	$139.44	$160.27
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.22 / $164.22 / $289.18	Professional	TC	$164.22	$164.22	$289.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $205.47 / $236.61 / $301.07	Professional		$205.47	$236.61	$301.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $66.37 / $69.86	Professional	26	$57.63	$66.37	$69.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.84 / $170.24 / $179.20	Professional	TC	$147.84	$170.24	$179.20
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $65.13 / $200.59	Professional		$32.34	$65.13	$200.59
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $187.50 / $187.50 / $187.50	Facility	26	$187.50	$187.50	$187.50
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $223.58 / $263.04 / $301.06	Professional		$223.58	$263.04	$301.06
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $62.31 / $73.30 / $88.48	Professional	26	$62.31	$73.30	$88.48
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $161.28 / $189.74 / $212.59	Professional	TC	$161.28	$189.74	$212.59
United Facility/Professional Professional Modifier Low / Median / High Price $144.13 / $153.24 / $262.49	Professional		$144.13	$153.24	$262.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.31 / $43.27 / $74.13	Professional	26	$39.31	$43.27	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.83 / $109.97 / $188.36	Professional	TC	$104.83	$109.97	$188.36