Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $91.20 / $95.50	Facility	26	$52.48	$91.20	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $169.82 / $467.74	Professional		$87.10	$169.82	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $61.66 / $151.36	Professional	26	$33.11	$61.66	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $74.13 / $208.93	Professional	TC	$47.86	$74.13	$208.93
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 $144.54 / $169.82 / $208.93	Professional		$144.54	$169.82	$208.93
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $67.61 / $75.86	Professional	26	$57.54	$67.61	$75.86
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $102.33 / $120.23	Professional	TC	$85.11	$102.33	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $141.25 / $245.47	Professional		$89.13	$141.25	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $56.23 / $79.43	Professional	26	$35.48	$56.23	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $89.13 / $131.83	Professional	TC	$54.95	$89.13	$131.83
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $338.84 / $338.84	Professional		$257.04	$338.84	$338.84
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $181.97 / $181.97	Professional	26	$154.88	$181.97	$181.97
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $154.88 / $154.88	Professional	TC	$100.00	$154.88	$154.88
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $91.20 / $114.82	Facility	26	$52.48	$91.20	$114.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $169.82 / $257.04	Professional		$97.72	$169.82	$257.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $66.07 / $100.00	Professional	26	$37.15	$66.07	$100.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $107.15 / $154.88	Professional	TC	$64.57	$107.15	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $28.18 / $33.11 / $70.79	Professional		$28.18	$33.11	$70.79
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 $128.82 / $186.21 / $199.53	Professional		$128.82	$186.21	$199.53
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $72.44 / $75.86	Professional	26	$48.98	$72.44	$75.86
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $123.03	Professional	TC	$79.43	$112.20	$123.03
Select Health Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $87.10 / $199.53	Professional		$87.10	$87.10	$199.53
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $33.88 / $74.13	Professional	26	$33.88	$33.88	$74.13
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $57.54 / $112.20	Professional	TC	$52.48	$57.54	$112.20
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $104.71 / $208.93	Professional		$97.72	$104.71	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $38.90 / $74.13	Professional	26	$37.15	$38.90	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $69.18 / $134.90	Professional	TC	$58.88	$69.18	$134.90