Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $902.62 / $1,037.99 / $1,621.76	Professional		$902.62	$1,037.99	$1,621.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $158.08 / $187.33 / $550.84	Professional	26	$158.08	$187.33	$550.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $402.07 / $519.00 / $609.69	Professional	52	$402.07	$519.00	$609.69
Aetna Facility/Professional Professional Modifier 53 Low / Median / High Price $160.83 / $207.60 / $243.88	Professional	53	$160.83	$207.60	$243.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $747.63 / $843.98 / $1,057.59	Professional	TC	$747.63	$843.98	$1,057.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $942.89 / $1,257.18 / $1,571.48	Professional		$942.89	$1,257.18	$1,571.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $146.22 / $207.15 / $254.07	Professional	26	$146.22	$207.15	$254.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $796.66 / $1,053.00 / $1,327.77	Professional	TC	$796.66	$1,053.00	$1,327.77
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $2,231.50 / $2,231.50 / $2,360.80	Professional		$2,231.50	$2,231.50	$2,360.80
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $405.99 / $405.99 / $508.56	Professional	26	$405.99	$405.99	$508.56
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,722.94 / $1,722.94 / $1,954.81	Professional	TC	$1,722.94	$1,722.94	$1,954.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,114.94 / $1,197.57 / $1,351.44	Professional		$1,114.94	$1,197.57	$1,351.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $176.12 / $202.81 / $236.96	Professional	26	$176.12	$202.81	$236.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $938.80 / $1,015.58 / $1,137.94	Professional	TC	$938.80	$1,015.58	$1,137.94
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $200.30 / $1,083.61	Professional		$32.34	$200.30	$1,083.61
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,570.62 / $1,570.62 / $1,570.62	Facility	26	$1,570.62	$1,570.62	$1,570.62
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $893.16 / $1,023.83 / $1,197.56	Professional		$893.16	$1,023.83	$1,197.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $131.13 / $154.28 / $187.02	Professional	26	$131.13	$154.28	$187.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $766.00 / $869.55 / $1,010.54	Professional	TC	$766.00	$869.55	$1,010.54
United Facility/Professional Professional Modifier Low / Median / High Price $879.50 / $1,267.24 / $1,740.06	Professional		$879.50	$1,267.24	$1,740.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.09 / $212.39 / $344.41	Professional	26	$132.09	$212.39	$344.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $747.41 / $1,008.92 / $1,408.27	Professional	TC	$747.41	$1,008.92	$1,408.27