Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $131.83 / $138.04	Facility	26	$66.07	$131.83	$138.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $245.47 / $562.34	Professional		$134.90	$245.47	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $64.57 / $173.78	Professional	26	$45.71	$64.57	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $177.83 / $389.05	Professional	TC	$83.18	$177.83	$389.05
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $229.09 / $245.47 / $346.74	Professional		$229.09	$245.47	$346.74
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $95.50 / $134.90	Professional	26	$89.13	$95.50	$134.90
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $151.36 / $213.80	Professional	TC	$141.25	$151.36	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $194.98 / $389.05	Professional		$112.20	$194.98	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $117.49	Professional	26	$42.66	$63.10	$117.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $123.03 / $269.15	Professional	TC	$69.18	$123.03	$269.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $724.44 / $977.24	Professional		$724.44	$724.44	$977.24
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $446.68 / $446.68	Professional	26	$436.52	$446.68	$446.68
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $281.84 / $537.03	Professional	TC	$281.84	$281.84	$537.03
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $134.90 / $151.36	Facility	26	$74.13	$134.90	$151.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $263.03 / $478.63	Professional		$169.82	$263.03	$478.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $93.33 / $138.04	Professional	26	$48.98	$93.33	$138.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $169.82 / $338.84	Professional	TC	$120.23	$169.82	$338.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $89.13	Professional		$32.36	$33.11	$89.13
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Facility	26	$213.80	$213.80	$213.80
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $281.84 / $380.19	Professional		$213.80	$281.84	$380.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $102.33 / $128.82	Professional	26	$83.18	$102.33	$128.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $295.12	Professional	TC	$120.23	$177.83	$295.12
Select Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $125.89 / $426.58	Professional		$123.03	$125.89	$426.58
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $47.86 / $114.82	Professional	26	$47.86	$47.86	$114.82
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $85.11 / $275.42	Professional	TC	$75.86	$85.11	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $199.53 / $436.52	Professional		$138.04	$199.53	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $58.88 / $112.20	Professional	26	$42.66	$58.88	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $158.49 / $323.59	Professional	TC	$87.10	$158.49	$323.59