Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $100.00 / $263.03	Facility	26	$91.20	$100.00	$263.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $524.81 / $1,380.38	Professional		$338.84	$524.81	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $141.25 / $263.03	Professional	26	$70.79	$141.25	$263.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $363.08 / $933.25	Professional	TC	$263.03	$363.08	$933.25
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
BCBS Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $602.56 / $851.14	Professional		$575.44	$602.56	$851.14
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $131.83 / $181.97	Professional	26	$112.20	$131.83	$181.97
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $478.63 / $660.69	Professional	TC	$457.09	$478.63	$660.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $537.03 / $1,096.48	Professional		$281.84	$537.03	$1,096.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $169.82	Professional	26	$58.88	$87.10	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $407.38 / $977.24	Professional	TC	$223.87	$407.38	$977.24
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $2,511.89 / $2,511.89 / $2,754.23	Professional		$2,511.89	$2,511.89	$2,754.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $977.24 / $977.24 / $977.24	Professional	26	$977.24	$977.24	$977.24
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,513.56 / $1,513.56 / $1,778.28	Professional	TC	$1,513.56	$1,513.56	$1,778.28
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $234.42 / $269.15	Facility	26	$91.20	$234.42	$269.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $645.65 / $1,096.48	Professional		$478.63	$645.65	$1,096.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $134.90 / $190.55	Professional	26	$104.71	$134.90	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $512.86 / $933.25	Professional	TC	$338.84	$512.86	$933.25
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $218.78	Professional		$32.36	$33.11	$218.78
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $707.95 / $707.95 / $707.95	Facility	26	$707.95	$707.95	$707.95
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $524.81 / $691.83 / $1,258.93	Professional		$524.81	$691.83	$1,258.93
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $141.25 / $173.78	Professional	26	$114.82	$141.25	$173.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $380.19 / $549.54 / $1,096.48	Professional	TC	$380.19	$549.54	$1,096.48
Select Health Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $309.03 / $1,318.26	Professional		$302.00	$309.03	$1,318.26
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $64.57 / $169.82	Professional	26	$64.57	$64.57	$169.82
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $269.15 / $912.01	Professional	TC	$239.88	$269.15	$912.01
United Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $676.08 / $1,445.44	Professional		$323.59	$676.08	$1,445.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $79.43 / $173.78	Professional	26	$64.57	$79.43	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $512.86 / $1,230.27	Professional	TC	$257.04	$512.86	$1,230.27