Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $319.10 / $319.10 / $319.10	Facility	TC	$319.10	$319.10	$319.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.36 / $71.89 / $115.00	Professional		$42.36	$71.89	$115.00
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $71.59 / $71.59 / $71.59	Professional	25	$71.59	$71.59	$71.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $26.96 / $60.78	Professional	26	$22.01	$26.96	$60.78
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $234.74 / $234.74 / $281.35	Professional	50	$234.74	$234.74	$281.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $21.30 / $28.78 / $37.63	Professional	52	$21.30	$28.78	$37.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.98 / $30.45 / $89.30	Professional	TC	$21.98	$30.45	$89.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $65.30 / $97.00	Professional		$48.98	$65.30	$97.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.39 / $32.07 / $40.45	Professional	26	$25.39	$32.07	$40.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.68 / $29.49 / $61.50	Professional	TC	$21.68	$29.49	$61.50
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $85.46 / $85.46 / $97.40	Professional		$85.46	$85.46	$97.40
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.72 / $36.72 / $47.00	Professional	26	$36.72	$36.72	$47.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.46 / $38.46 / $60.68	Professional	TC	$38.46	$38.46	$60.68
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $39.58 / $71.00 / $113.07	Facility		$39.58	$71.00	$113.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $58.71 / $62.27 / $78.98	Professional		$58.71	$62.27	$78.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.54 / $34.53 / $39.46	Professional	26	$32.54	$34.53	$39.46
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.15 / $30.12 / $44.38	Professional	TC	$26.15	$30.12	$44.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $22.09 / $32.34 / $64.76	Professional		$22.09	$32.34	$64.76
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $230.28 / $312.54 / $387.23	Facility		$230.28	$312.54	$387.23
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $217.18 / $217.18 / $217.18	Facility	26	$217.18	$217.18	$217.18
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $217.18 / $217.18 / $217.18	Facility	TC	$217.18	$217.18	$217.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $47.18 / $49.73 / $60.93	Professional		$47.18	$49.73	$60.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $25.93 / $27.33 / $35.19	Professional	26	$25.93	$27.33	$35.19
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $21.25 / $22.40 / $25.74	Professional	TC	$21.25	$22.40	$25.74
United Facility/Professional Professional Modifier Low / Median / High Price $45.83 / $74.92 / $134.99	Professional		$45.83	$74.92	$134.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $32.01 / $42.85	Professional	26	$22.01	$32.01	$42.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.82 / $44.88 / $94.18	Professional	TC	$23.82	$44.88	$94.18