Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $38.90 / $70.79	Facility	26	$38.90	$38.90	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $281.84	Professional		$91.20	$125.89	$281.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $25.70 / $58.88	Professional	26	$19.95	$25.70	$58.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $100.00 / $208.93	Professional	TC	$70.79	$100.00	$208.93
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 $199.53 / $234.42 / $331.13	Professional		$199.53	$234.42	$331.13
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $50.12 / $70.79	Professional	26	$42.66	$50.12	$70.79
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.49 / $186.21 / $257.04	Professional	TC	$158.49	$186.21	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $186.21 / $245.47	Professional		$104.71	$186.21	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $40.74 / $54.95	Professional	26	$26.92	$40.74	$54.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $138.04 / $186.21	Professional	TC	$74.13	$138.04	$186.21
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $323.59 / $512.86	Professional		$323.59	$323.59	$512.86
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $120.23 / $120.23	Professional	26	$112.20	$120.23	$120.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $208.93 / $398.11	Professional	TC	$208.93	$208.93	$398.11
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $38.90 / $67.61	Facility	26	$34.67	$38.90	$67.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $257.04 / $302.00	Professional		$123.03	$257.04	$302.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $52.48 / $58.88	Professional	26	$25.12	$52.48	$58.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $204.17 / $239.88	Professional	TC	$93.33	$204.17	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $33.11 / $85.11	Professional		$21.38	$33.11	$85.11
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 $181.97 / $263.03 / $316.23	Professional		$181.97	$263.03	$316.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $53.70 / $66.07	Professional	26	$43.65	$53.70	$66.07
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $208.93 / $251.19	Professional	TC	$147.91	$208.93	$251.19
Select Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $128.82 / $281.84	Professional		$125.89	$128.82	$281.84
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $25.70 / $57.54	Professional	26	$25.70	$25.70	$57.54
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $112.20 / $218.78	Professional	TC	$100.00	$112.20	$218.78
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $123.03 / $229.09	Professional		$109.65	$123.03	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $28.18 / $56.23	Professional	26	$27.54	$28.18	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $93.33 / $173.78	Professional	TC	$83.18	$93.33	$173.78