Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $299.07 / $962.72 / $1,212.04	Facility		$299.07	$962.72	$1,212.04
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.58 / $55.06 / $62.19	Facility	26	$48.58	$55.06	$62.19
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $244.00 / $307.57 / $1,195.09	Facility	TC	$244.00	$307.57	$1,195.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.40 / $214.07 / $365.80	Professional		$154.40	$214.07	$365.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.89 / $41.91 / $132.63	Professional	26	$31.89	$41.91	$132.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $140.83 / $178.73 / $264.01	Professional	TC	$140.83	$178.73	$264.01
Cigna Facility/Professional Facility Modifier Low / Median / High Price $314.62 / $776.70 / $1,344.59	Facility		$314.62	$776.70	$1,344.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $213.04 / $293.14 / $364.64	Professional		$213.04	$293.14	$364.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.86 / $51.00 / $65.36	Professional	26	$35.86	$51.00	$65.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $174.78 / $247.60 / $296.73	Professional	TC	$174.78	$247.60	$296.73
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $314.08 / $314.08 / $718.93	Professional		$314.08	$314.08	$718.93
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.65 / $120.65 / $137.66	Professional	26	$120.65	$120.65	$137.66
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $176.42 / $176.42 / $598.28	Professional	TC	$176.42	$176.42	$598.28
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $179.69 / $274.08 / $520.46	Facility		$179.69	$274.08	$520.46
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.14 / $313.04 / $357.76	Professional		$295.14	$313.04	$357.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $54.34 / $62.10	Professional	26	$51.23	$54.34	$62.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $243.90 / $258.69 / $295.64	Professional	TC	$243.90	$258.69	$295.64
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $57.64 / $318.52	Professional		$32.34	$57.64	$318.52
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $445.42 / $635.64 / $778.79	Facility		$445.42	$635.64	$778.79
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.45 / $446.45 / $446.45	Facility	26	$446.45	$446.45	$446.45
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $446.45 / $446.45 / $446.45	Facility	TC	$446.45	$446.45	$446.45
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $261.49 / $279.10 / $301.70	Professional		$261.49	$279.10	$301.70
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $45.69 / $48.26 / $54.86	Professional	26	$45.69	$48.26	$54.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $215.75 / $230.84 / $246.85	Professional	TC	$215.75	$230.84	$246.85
United Facility/Professional Professional Modifier Low / Median / High Price $209.38 / $319.99 / $429.52	Professional		$209.38	$319.99	$429.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.64 / $48.52 / $62.37	Professional	26	$35.64	$48.52	$62.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $172.13 / $271.49 / $374.08	Professional	TC	$172.13	$271.49	$374.08