Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $218.78 / $316.23 / $316.23	Facility	26	$218.78	$316.23	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $478.63 / $851.14	Professional		$281.84	$478.63	$851.14
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $141.25 / $338.84	Professional	26	$85.11	$141.25	$338.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $288.40 / $588.84 / $812.83	Professional	52	$288.40	$588.84	$812.83
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $338.84 / $676.08	Professional	TC	$194.98	$338.84	$676.08
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 $446.68 / $501.19 / $707.95	Professional		$446.68	$501.19	$707.95
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $158.49 / $223.87	Professional	26	$134.90	$158.49	$223.87
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $346.74 / $478.63	Professional	TC	$316.23	$346.74	$478.63
Cigna Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $389.05 / $776.25	Professional		$234.42	$389.05	$776.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $100.00 / $177.83	Professional	26	$70.79	$100.00	$177.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $275.42 / $630.96	Professional	TC	$162.18	$275.42	$630.96
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $1,819.70	Professional		$1,621.81	$1,621.81	$1,819.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $602.56 / $724.44 / $724.44	Professional	26	$602.56	$724.44	$724.44
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $912.01 / $912.01 / $1,230.27	Professional	TC	$912.01	$912.01	$1,230.27
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $316.23 / $316.23 / $316.23	Facility	26	$316.23	$316.23	$316.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $446.68 / $537.03 / $977.24	Professional		$446.68	$537.03	$977.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $162.18 / $229.09	Professional	26	$120.23	$162.18	$229.09
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $288.40 / $588.84 / $812.83	Professional	52	$288.40	$588.84	$812.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $371.54 / $676.08	Professional	TC	$302.00	$371.54	$676.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $181.97	Professional		$32.36	$33.11	$181.97
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 $416.87 / $575.44 / $870.96	Professional		$416.87	$575.44	$870.96
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $169.82 / $213.80	Professional	26	$138.04	$169.82	$213.80
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $407.38 / $724.44	Professional	TC	$275.42	$407.38	$724.44
Select Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $257.04 / $977.24	Professional		$251.19	$257.04	$977.24
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $194.98	Professional	26	$79.43	$79.43	$194.98
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $194.98 / $891.25	Professional	TC	$169.82	$194.98	$891.25
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $457.09 / $977.24	Professional		$269.15	$457.09	$977.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $91.20 / $173.78	Professional	26	$74.13	$91.20	$173.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $354.81 / $794.33	Professional	TC	$190.55	$354.81	$794.33