Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $201.91 / $379.28 / $379.28	Facility		$201.91	$379.28	$379.28
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.40 / $35.40 / $35.40	Facility	26	$35.40	$35.40	$35.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.07 / $182.98 / $235.21	Professional		$141.07	$182.98	$235.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.98 / $23.60 / $39.60	Professional	26	$20.98	$23.60	$39.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.14 / $84.84 / $96.63	Professional	52	$60.14	$84.84	$96.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.47 / $157.59 / $197.70	Professional	TC	$117.47	$157.59	$197.70
Cigna Facility/Professional Facility Modifier Low / Median / High Price $190.90 / $470.99 / $857.14	Facility		$190.90	$470.99	$857.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $143.08 / $202.69 / $275.18	Professional		$143.08	$202.69	$275.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.57 / $32.65 / $41.83	Professional	26	$23.57	$32.65	$41.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.59 / $168.00 / $207.11	Professional	TC	$118.59	$168.00	$207.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $442.37 / $442.37 / $512.79	Professional		$442.37	$442.37	$512.79
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $69.86 / $69.86 / $86.88	Professional	26	$69.86	$69.86	$86.88
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $355.49 / $355.49 / $442.94	Professional	TC	$355.49	$355.49	$442.94
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $130.18 / $193.25 / $272.92	Facility		$130.18	$193.25	$272.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $207.62 / $220.20 / $251.66	Professional		$207.62	$220.20	$251.66
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.63 / $35.67 / $40.76	Professional	26	$33.63	$35.67	$40.76
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $173.99 / $184.54 / $210.90	Professional	TC	$173.99	$184.54	$210.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $37.28 / $223.14	Professional		$32.34	$37.28	$223.14
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $270.73 / $386.99 / $485.01	Facility		$270.73	$386.99	$485.01
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $270.73 / $270.73 / $270.73	Facility	26	$270.73	$270.73	$270.73
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $177.41 / $194.52 / $204.56	Professional		$177.41	$194.52	$204.56
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.03 / $31.84 / $35.22	Professional	26	$30.03	$31.84	$35.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $147.38 / $162.68 / $169.34	Professional	TC	$147.38	$162.68	$169.34
United Facility/Professional Professional Modifier Low / Median / High Price $142.12 / $202.51 / $269.99	Professional		$142.12	$202.51	$269.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.43 / $34.26 / $45.92	Professional	26	$23.43	$34.26	$45.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $118.18 / $184.04 / $237.21	Professional	TC	$118.18	$184.04	$237.21