Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $83.18 / $213.80 / $257.04	Facility	26	$83.18	$213.80	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $562.34 / $1,380.38	Professional		$190.55	$562.34	$1,380.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $138.04 / $338.84	Professional	26	$64.57	$138.04	$338.84
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional	50	$1,230.27	$1,230.27	$1,230.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $338.84 / $630.96	Professional	TC	$151.36	$338.84	$630.96
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $380.19 / $524.81	Professional		$331.13	$380.19	$524.81
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $120.23 / $169.82	Professional	26	$102.33	$120.23	$169.82
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $257.04 / $354.81	Professional	TC	$229.09	$257.04	$354.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $288.40 / $630.96	Professional		$173.78	$288.40	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $74.13 / $169.82	Professional	26	$53.70	$74.13	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $199.53 / $446.68	Professional	TC	$120.23	$199.53	$446.68
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,445.44 / $1,995.26	Professional		$1,445.44	$1,445.44	$1,995.26
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $537.03 / $537.03	Professional	26	$281.84	$537.03	$537.03
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $891.25 / $891.25 / $1,698.24	Professional	TC	$891.25	$891.25	$1,698.24
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $93.33 / $245.47 / $257.04	Facility	26	$93.33	$245.47	$257.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $446.68 / $977.24	Professional		$251.19	$446.68	$977.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $125.89 / $204.17	Professional	26	$79.43	$125.89	$204.17
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional	50	$1,230.27	$1,230.27	$1,230.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $281.84 / $645.65	Professional	TC	$208.93	$281.84	$645.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $134.90	Professional		$32.36	$33.11	$134.90
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $436.52 / $537.03	Professional		$316.23	$436.52	$537.03
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $128.82 / $162.18	Professional	26	$104.71	$128.82	$162.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $204.17 / $302.00 / $389.05	Professional	TC	$204.17	$302.00	$389.05
Select Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $194.98 / $575.44	Professional		$190.55	$194.98	$575.44
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $60.26 / $147.91	Professional	26	$60.26	$60.26	$147.91
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $144.54 / $630.96	Professional	TC	$128.82	$144.54	$630.96
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $371.54 / $776.25	Professional		$199.53	$371.54	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $70.79 / $134.90	Professional	26	$57.54	$70.79	$134.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $263.03 / $575.44	Professional	TC	$138.04	$263.03	$575.44