Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $40.74 / $75.86	Facility	26	$40.74	$40.74	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $123.03 / $269.15	Professional		$89.13	$123.03	$269.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.18 / $75.86	Professional	26	$21.88	$28.18	$75.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $97.72 / $213.80	Professional	TC	$67.61	$97.72	$213.80
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 $190.55 / $223.87 / $316.23	Professional		$190.55	$223.87	$316.23
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $52.48 / $72.44	Professional	26	$44.67	$52.48	$72.44
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $173.78 / $245.47	Professional	TC	$147.91	$173.78	$245.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $190.55 / $245.47	Professional		$102.33	$190.55	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $42.66 / $57.54	Professional	26	$28.84	$42.66	$57.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $141.25 / $190.55	Professional	TC	$69.18	$141.25	$190.55
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $316.23 / $457.09	Professional		$316.23	$316.23	$457.09
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $120.23 / $120.23	Professional	26	$87.10	$120.23	$120.23
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $194.98 / $371.54	Professional	TC	$194.98	$194.98	$371.54
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $40.74 / $61.66	Facility	26	$40.74	$40.74	$61.66
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $251.19 / $295.12	Professional		$112.20	$251.19	$295.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $53.70 / $63.10	Professional	26	$25.70	$53.70	$63.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $199.53 / $234.42	Professional	TC	$85.11	$199.53	$234.42
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.88 / $33.11 / $81.28	Professional		$21.88	$33.11	$81.28
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 $186.21 / $263.03 / $316.23	Professional		$186.21	$263.03	$316.23
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $54.95 / $69.18	Professional	26	$44.67	$54.95	$69.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $208.93 / $245.47	Professional	TC	$144.54	$208.93	$245.47
Select Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $125.89 / $281.84	Professional		$123.03	$125.89	$281.84
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $26.92 / $60.26	Professional	26	$26.92	$26.92	$60.26
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $107.15 / $213.80	Professional	TC	$95.50	$107.15	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $125.89 / $234.42	Professional		$107.15	$125.89	$234.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $30.20 / $60.26	Professional	26	$28.18	$30.20	$60.26
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $95.50 / $173.78	Professional	TC	$77.62	$95.50	$173.78