Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $123.03 / $162.18	Facility	26	$61.66	$123.03	$162.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $234.42 / $467.74	Professional		$131.83	$234.42	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $54.95 / $158.49	Professional	26	$42.66	$54.95	$158.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $165.96 / $380.19	Professional	TC	$83.18	$165.96	$380.19
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 / $239.88 / $338.84	Professional		$229.09	$239.88	$338.84
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $89.13 / $123.03	Professional	26	$81.28	$89.13	$123.03
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $154.88 / $213.80	Professional	TC	$144.54	$154.88	$213.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $218.78 / $389.05	Professional		$109.65	$218.78	$389.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $63.10 / $112.20	Professional	26	$39.81	$63.10	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $151.36 / $269.15	Professional	TC	$69.18	$151.36	$269.15
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $758.58 / $758.58	Professional		$512.86	$758.58	$758.58
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $245.47 / $245.47 / $251.19	Professional	26	$245.47	$245.47	$251.19
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $512.86 / $512.86	Professional	TC	$263.03	$512.86	$512.86
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $125.89 / $158.49	Facility	26	$69.18	$125.89	$158.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $257.04 / $436.52	Professional		$169.82	$257.04	$436.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $89.13 / $128.82	Professional	26	$46.77	$89.13	$128.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $169.82 / $331.13	Professional	TC	$120.23	$169.82	$331.13
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $87.10	Professional		$32.36	$33.11	$87.10
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 / $275.42 / $389.05	Professional		$213.80	$275.42	$389.05
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $93.33 / $120.23	Professional	26	$77.62	$93.33	$120.23
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $181.97 / $295.12	Professional	TC	$120.23	$181.97	$295.12
Select Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $125.89 / $489.78	Professional		$123.03	$125.89	$489.78
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $44.67 / $104.71	Professional	26	$44.67	$44.67	$104.71
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $87.10 / $275.42	Professional	TC	$77.62	$87.10	$275.42
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $204.17 / $446.68	Professional		$134.90	$204.17	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $107.15	Professional	26	$43.65	$53.70	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $158.49 / $331.13	Professional	TC	$91.20	$158.49	$331.13