Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.11 / $85.11 / $85.11	Facility	26	$85.11	$85.11	$85.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $177.83 / $354.81	Professional		$117.49	$177.83	$354.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $36.31 / $97.72	Professional	26	$26.92	$36.31	$97.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $104.71 / $186.21	Professional	TC	$70.79	$104.71	$186.21
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 $218.78 / $257.04 / $363.08	Professional		$218.78	$257.04	$363.08
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $61.66 / $69.18	Professional	26	$52.48	$61.66	$69.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $194.98 / $288.40	Professional	TC	$165.96	$194.98	$288.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $257.04 / $398.11	Professional		$120.23	$257.04	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $50.12 / $70.79	Professional	26	$31.62	$50.12	$70.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $177.83 / $288.40	Professional	TC	$79.43	$177.83	$288.40
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $346.74 / $436.52	Professional		$346.74	$346.74	$436.52
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $114.82 / $302.00	Professional	26	$114.82	$114.82	$302.00
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $229.09 / $229.09	Professional	TC	$131.83	$229.09	$229.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $218.78 / $338.84	Professional		$134.90	$218.78	$338.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $57.54 / $74.13	Professional	26	$32.36	$57.54	$74.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $158.49 / $245.47	Professional	TC	$100.00	$158.49	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.70 / $33.11 / $93.33	Professional		$25.70	$33.11	$93.33
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 $186.21 / $354.81 / $426.58	Professional		$186.21	$354.81	$426.58
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $69.18	Professional	26	$43.65	$63.10	$69.18
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $295.12 / $354.81	Professional	TC	$120.23	$295.12	$354.81
Select Health Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $125.89 / $346.74	Professional		$112.20	$125.89	$346.74
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $30.90 / $67.61	Professional	26	$30.90	$30.90	$67.61
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $95.50 / $288.40	Professional	TC	$81.28	$95.50	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $158.49 / $275.42	Professional		$138.04	$158.49	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $36.31 / $67.61	Professional	26	$33.88	$36.31	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $125.89 / $208.93	Professional	TC	$100.00	$125.89	$208.93