Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $117.49	Facility	26	$114.82	$114.82	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $138.04 / $309.03	Professional		$79.43	$138.04	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $42.66 / $95.50	Professional	26	$16.60	$42.66	$95.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $79.43 / $275.42	Professional	TC	$40.74	$79.43	$275.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $177.83 / $245.47	Professional		$151.36	$177.83	$245.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $85.11 / $120.23	Professional	26	$72.44	$85.11	$120.23
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $91.20 / $125.89	Professional	TC	$77.62	$91.20	$125.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $158.49 / $239.88	Professional		$102.33	$158.49	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $53.70 / $89.13	Professional	26	$19.50	$53.70	$89.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $89.13 / $181.97	Professional	TC	$61.66	$89.13	$181.97
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $416.87 / $416.87	Professional		$288.40	$416.87	$416.87
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $302.00 / $302.00	Professional	26	$72.44	$302.00	$302.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $120.23 / $218.78	Professional	TC	$120.23	$120.23	$218.78
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $181.97 / $309.03	Professional		$107.15	$181.97	$309.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $77.62 / $123.03	Professional	26	$30.90	$77.62	$123.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $100.00 / $229.09	Professional	TC	$58.88	$100.00	$229.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $63.10	Professional		$32.36	$33.11	$63.10
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $199.53 / $245.47	Professional		$158.49	$199.53	$245.47
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $91.20 / $114.82	Professional	26	$30.90	$91.20	$114.82
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $107.15 / $154.88	Professional	TC	$85.11	$107.15	$154.88
Select Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $91.20 / $331.13	Professional		$89.13	$91.20	$331.13
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $42.66 / $95.50	Professional	26	$41.69	$42.66	$95.50
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $47.86 / $100.00	Professional	TC	$46.77	$47.86	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $131.83 / $288.40	Professional		$109.65	$131.83	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $50.12 / $79.43	Professional	26	$17.78	$50.12	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $102.33 / $213.80	Professional	TC	$60.26	$102.33	$213.80