Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $19.05 / $19.05	Facility	26	$16.98	$19.05	$19.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $67.61 / $134.90	Professional		$47.86	$67.61	$134.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $14.13 / $31.62	Professional	26	$10.00	$14.13	$31.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $47.86 / $89.13	Professional	TC	$33.88	$47.86	$89.13
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 $93.33 / $109.65 / $154.88	Professional		$93.33	$109.65	$154.88
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $25.12 / $34.67	Professional	26	$21.38	$25.12	$34.67
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $85.11 / $117.49	Professional	TC	$72.44	$85.11	$117.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $85.11 / $109.65	Professional		$53.70	$85.11	$109.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $19.95 / $28.18	Professional	26	$14.13	$19.95	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $61.66 / $83.18	Professional	TC	$37.15	$61.66	$83.18
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $398.11	Professional		$186.21	$186.21	$398.11
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	26	$93.33	$93.33	$93.33
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $95.50	Professional	TC	$95.50	$95.50	$95.50
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $19.05 / $19.05	Facility	26	$16.98	$19.05	$19.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $109.65 / $138.04	Professional		$52.48	$109.65	$138.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $25.12 / $29.51	Professional	26	$12.88	$25.12	$29.51
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $89.13 / $109.65	Professional	TC	$38.02	$89.13	$109.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $10.47 / $32.36 / $39.81	Professional		$10.47	$32.36	$39.81
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 $85.11 / $117.49 / $141.25	Professional		$85.11	$117.49	$141.25
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $26.30 / $33.11	Professional	26	$21.38	$26.30	$33.11
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $89.13 / $109.65	Professional	TC	$63.10	$89.13	$109.65
Select Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $57.54 / $128.82	Professional		$57.54	$57.54	$128.82
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $12.59 / $28.84	Professional	26	$12.59	$12.59	$28.84
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $46.77 / $97.72	Professional	TC	$45.71	$46.77	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $57.54 / $107.15	Professional		$48.98	$57.54	$107.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $14.79 / $26.92	Professional	26	$13.80	$14.79	$26.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.48 / $42.66 / $79.43	Professional	TC	$35.48	$42.66	$79.43