Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $208.60 / $536.40 / $1,009.36	Facility		$208.60	$536.40	$1,009.36
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.09 / $83.09 / $83.09	Facility	26	$83.09	$83.09	$83.09
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $70.05 / $540.23 / $810.35	Facility	TC	$70.05	$540.23	$810.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $105.54 / $128.69 / $153.15	Professional		$105.54	$128.69	$153.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.95 / $69.83 / $230.44	Professional	26	$32.95	$69.83	$230.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $58.15 / $64.34 / $64.34	Professional	52	$58.15	$64.34	$64.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $58.87 / $70.05 / $79.29	Professional	TC	$58.87	$70.05	$79.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.79 / $55.79 / $65.63	Professional		$55.79	$55.79	$65.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.78 / $30.69 / $36.11	Professional	26	$29.78	$30.69	$36.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.09 / $25.09 / $29.52	Professional	TC	$25.09	$25.09	$29.52
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $100.47 / $128.69 / $169.00	Facility		$100.47	$128.69	$169.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $114.76 / $116.78 / $128.66	Professional		$114.76	$116.78	$128.66
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $57.63 / $61.13 / $64.62	Professional	26	$57.63	$61.13	$64.62
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.11 / $60.57 / $64.03	Professional	TC	$57.11	$60.57	$64.03
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $61.00 / $126.93	Professional		$32.34	$61.00	$126.93
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $111.64 / $123.38 / $125.88	Professional		$111.64	$123.38	$125.88
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $61.84 / $63.23 / $63.55	Professional	26	$61.84	$63.23	$63.55
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $48.09 / $60.53 / $62.65	Professional	TC	$48.09	$60.53	$62.65
United Facility/Professional Professional Modifier Low / Median / High Price $42.88 / $63.52 / $87.71	Professional		$42.88	$63.52	$87.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.65 / $23.61 / $46.71	Professional	26	$21.65	$23.61	$46.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $19.27 / $35.65 / $41.87	Professional	TC	$19.27	$35.65	$41.87