Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $21.38 / $38.02	Facility	26	$19.50	$21.38	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $100.00 / $251.19	Professional		$58.88	$100.00	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $22.39 / $60.26	Professional	26	$12.88	$22.39	$60.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $58.88 / $109.65	Professional	TC	$42.66	$58.88	$109.65
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 $109.65 / $128.82 / $177.83	Professional		$109.65	$128.82	$177.83
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $28.18 / $39.81	Professional	26	$23.99	$28.18	$39.81
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $100.00 / $138.04	Professional	TC	$85.11	$100.00	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $100.00 / $128.82	Professional		$64.57	$100.00	$128.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $22.91 / $32.36	Professional	26	$15.85	$22.91	$32.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $75.86 / $100.00	Professional	TC	$46.77	$75.86	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $229.09 / $229.09	Professional		$169.82	$229.09	$229.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Professional	26	$104.71	$104.71	$104.71
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $120.23 / $120.23	Professional	TC	$64.57	$120.23	$120.23
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.50 / $21.38 / $38.02	Facility	26	$19.50	$21.38	$38.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $134.90 / $199.53	Professional		$64.57	$134.90	$199.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $28.84 / $41.69	Professional	26	$14.45	$28.84	$41.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $100.00 / $125.89	Professional	TC	$45.71	$100.00	$125.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.02 / $33.11 / $45.71	Professional		$12.02	$33.11	$45.71
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 $102.33 / $138.04 / $169.82	Professional		$102.33	$138.04	$169.82
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.20 / $38.02	Professional	26	$24.55	$30.20	$38.02
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $109.65 / $131.83	Professional	TC	$75.86	$109.65	$131.83
Select Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $66.07 / $169.82	Professional		$66.07	$66.07	$169.82
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $14.45 / $33.11	Professional	26	$14.45	$14.45	$33.11
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $53.70 / $114.82	Professional	TC	$52.48	$53.70	$114.82
United Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $69.18 / $128.82	Professional		$60.26	$69.18	$128.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $16.98 / $31.62	Professional	26	$15.49	$16.98	$31.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $52.48 / $97.72	Professional	TC	$43.65	$52.48	$97.72