Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $112.55 / $693.44 / $831.07	Facility		$112.55	$693.44	$831.07
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $31.05 / $35.20 / $44.36	Facility	26	$31.05	$35.20	$44.36
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $142.19 / $346.53 / $800.80	Facility	TC	$142.19	$346.53	$800.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.08 / $135.78 / $233.62	Professional		$52.08	$135.78	$233.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.26 / $28.34 / $87.66	Professional	26	$20.26	$28.34	$87.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.54 / $112.49 / $183.21	Professional	TC	$89.54	$112.49	$183.21
Cigna Facility/Professional Facility Modifier Low / Median / High Price $148.86 / $367.78 / $603.27	Facility		$148.86	$367.78	$603.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $133.09 / $189.72 / $228.77	Professional		$133.09	$189.72	$228.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.43 / $32.60 / $42.16	Professional	26	$23.43	$32.60	$42.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.24 / $154.75 / $187.54	Professional	TC	$109.24	$154.75	$187.54
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $321.29 / $321.29 / $364.61	Professional		$321.29	$321.29	$364.61
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.05 / $77.05 / $83.41	Professional	26	$77.05	$77.05	$83.41
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $244.24 / $244.24 / $281.20	Professional	TC	$244.24	$244.24	$281.20
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $115.05 / $173.50 / $343.31	Facility		$115.05	$173.50	$343.31
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $188.94 / $200.39 / $229.02	Professional		$188.94	$200.39	$229.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.08 / $35.09 / $40.10	Professional	26	$33.08	$35.09	$40.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $155.84 / $165.29 / $188.90	Professional	TC	$155.84	$165.29	$188.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.34 / $37.28 / $203.95	Professional		$32.34	$37.28	$203.95
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $208.18 / $294.35 / $356.44	Facility		$208.18	$294.35	$356.44
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $211.40 / $211.40 / $211.40	Facility	26	$211.40	$211.40	$211.40
Regence BlueShield Facility/Professional Facility Modifier TC Low / Median / High Price $211.40 / $211.40 / $211.40	Facility	TC	$211.40	$211.40	$211.40
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $165.86 / $177.61 / $191.30	Professional		$165.86	$177.61	$191.30
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $29.11 / $30.85 / $35.22	Professional	26	$29.11	$30.85	$35.22
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $136.75 / $146.76 / $156.07	Professional	TC	$136.75	$146.76	$156.07
United Facility/Professional Professional Modifier Low / Median / High Price $130.72 / $205.20 / $254.03	Professional		$130.72	$205.20	$254.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.40 / $32.77 / $45.92	Professional	26	$23.40	$32.77	$45.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.41 / $156.40 / $226.79	Professional	TC	$101.41	$156.40	$226.79