Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $319.80 / $1,677.60 / $2,452.09	Facility		$319.80	$1,677.60	$2,452.09
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.04 / $115.65 / $132.54	Facility	26	$102.04	$115.65	$132.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $189.66 / $263.27 / $762.84	Professional		$189.66	$263.27	$762.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.82 / $75.40 / $261.00	Professional	26	$61.82	$75.40	$261.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $134.74 / $183.15 / $330.31	Professional	TC	$134.74	$183.15	$330.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $225.03 / $309.70 / $396.28	Professional		$225.03	$309.70	$396.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.08 / $108.13 / $135.16	Professional	26	$72.08	$108.13	$135.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $143.93 / $203.90 / $245.88	Professional	TC	$143.93	$203.90	$245.88
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,121.45 / $1,121.45 / $1,240.60	Professional		$1,121.45	$1,121.45	$1,240.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $201.37 / $201.37 / $252.22	Professional	26	$201.37	$201.37	$252.22
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $920.08 / $920.08 / $988.39	Professional	TC	$920.08	$920.08	$988.39
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $201.59 / $299.05 / $1,732.64	Facility		$201.59	$299.05	$1,732.64
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $310.08 / $328.88 / $375.86	Professional		$310.08	$328.88	$375.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.81 / $114.35 / $130.68	Professional	26	$107.81	$114.35	$130.68
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $202.27 / $214.53 / $245.18	Professional	TC	$202.27	$214.53	$245.18
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $123.05 / $339.26	Professional		$32.34	$123.05	$339.26
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $973.00 / $1,240.49 / $1,677.94	Facility		$973.00	$1,240.49	$1,677.94
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $936.81 / $936.81 / $936.81	Facility	26	$936.81	$936.81	$936.81
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $288.01 / $293.02 / $390.57	Professional		$288.01	$293.02	$390.57
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $98.76 / $100.50 / $117.41	Professional	26	$98.76	$100.50	$117.41
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $189.25 / $192.53 / $256.60	Professional	TC	$189.25	$192.53	$256.60
United Facility/Professional Professional Modifier Low / Median / High Price $222.68 / $316.45 / $398.49	Professional		$222.68	$316.45	$398.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.31 / $98.82 / $132.88	Professional	26	$70.31	$98.82	$132.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.63 / $215.18 / $274.67	Professional	TC	$143.63	$215.18	$274.67