Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $239.88 / $354.81 / $562.34	Facility		$239.88	$354.81	$562.34
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $66.07 / $72.44	Facility	26	$35.48	$66.07	$72.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $154.88 / $549.54	Professional		$100.00	$154.88	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $45.71 / $112.20	Professional	26	$25.12	$45.71	$112.20
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $107.15 / $109.65	Professional	52	$43.65	$107.15	$109.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $102.33 / $208.93	Professional	TC	$70.79	$102.33	$208.93
BCBS Facility/Professional Facility Modifier Low / Median / High Price $169.82 / $323.59 / $478.63	Facility		$169.82	$323.59	$478.63
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 $169.82 / $199.53 / $245.47	Professional		$169.82	$199.53	$245.47
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $50.12 / $57.54	Professional	26	$42.66	$50.12	$57.54
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $147.91 / $177.83	Professional	TC	$125.89	$147.91	$177.83
Cigna Facility/Professional Facility Modifier Low / Median / High Price $147.91 / $371.54 / $602.56	Facility		$147.91	$371.54	$602.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $169.82 / $295.12	Professional		$104.71	$169.82	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $41.69 / $58.88	Professional	26	$26.30	$41.69	$58.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $128.82 / $194.98	Professional	TC	$77.62	$128.82	$194.98
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $338.84 / $338.84	Professional		$239.88	$338.84	$338.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	26	$134.90	$134.90	$134.90
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $204.17 / $204.17	Professional	TC	$102.33	$204.17	$204.17
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $186.21 / $478.63	Facility		$100.00	$186.21	$478.63
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $67.61 / $72.44	Facility	26	$38.90	$67.61	$72.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $194.98 / $269.15	Professional		$120.23	$194.98	$269.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $48.98 / $74.13	Professional	26	$26.92	$48.98	$74.13
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $43.65 / $107.15 / $109.65	Professional	52	$43.65	$107.15	$109.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $147.91 / $204.17	Professional	TC	$91.20	$147.91	$204.17
Molina Facility/Professional Professional Modifier Low / Median / High Price $21.38 / $33.11 / $70.79	Professional		$21.38	$33.11	$70.79
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $218.78 / $295.12 / $389.05	Facility		$218.78	$295.12	$389.05
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 $154.88 / $223.87 / $234.42	Professional		$154.88	$223.87	$234.42
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $53.70 / $57.54	Professional	26	$37.15	$53.70	$57.54
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $169.82 / $177.83	Professional	TC	$117.49	$169.82	$177.83
Select Health Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $102.33 / $269.15	Professional		$100.00	$102.33	$269.15
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $25.12 / $56.23	Professional	26	$25.12	$25.12	$56.23
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $85.11 / $162.18	Professional	TC	$75.86	$85.11	$162.18
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $123.03 / $245.47	Professional		$117.49	$123.03	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $28.84 / $54.95	Professional	26	$27.54	$28.84	$54.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $95.50 / $190.55	Professional	TC	$89.13	$95.50	$190.55