Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $100.00 / $186.21	Facility	26	$91.20	$100.00	$186.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $177.83 / $407.38	Professional		$131.83	$177.83	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $85.11 / $218.78	Professional	26	$54.95	$85.11	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $109.65 / $281.84	Professional	TC	$66.07	$109.65	$281.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $234.42 / $323.59	Professional		$199.53	$234.42	$323.59
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $131.83 / $162.18	Professional	26	$112.20	$131.83	$162.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $102.33 / $144.54	Professional	TC	$87.10	$102.33	$144.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $223.87 / $371.54	Professional		$147.91	$223.87	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $107.15 / $144.54	Professional	26	$63.10	$107.15	$144.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $117.49 / $173.78	Professional	TC	$79.43	$117.49	$173.78
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $707.95 / $794.33	Professional		$707.95	$707.95	$794.33
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $218.78 / $562.34 / $562.34	Professional	26	$218.78	$562.34	$562.34
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $154.88 / $154.88	Professional	TC	$154.88	$154.88	$154.88
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $91.20 / $162.18 / $234.42	Facility	26	$91.20	$162.18	$234.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $346.74	Professional		$138.04	$234.42	$346.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $120.23 / $173.78	Professional	26	$64.57	$120.23	$173.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $109.65 / $208.93	Professional	TC	$69.18	$109.65	$208.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $83.18	Professional		$32.36	$33.11	$83.18
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $269.15 / $346.74	Professional		$194.98	$269.15	$346.74
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $138.04 / $173.78	Professional	26	$95.50	$138.04	$173.78
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $134.90 / $169.82	Professional	TC	$100.00	$134.90	$169.82
Select Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $117.49 / $346.74	Professional		$114.82	$117.49	$346.74
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $64.57 / $144.54	Professional	26	$64.57	$64.57	$144.54
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $51.29 / $123.03	Professional	TC	$51.29	$51.29	$123.03
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $154.88 / $302.00	Professional		$125.89	$154.88	$302.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $64.57 / $125.89	Professional	26	$46.77	$64.57	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $81.28 / $204.17	Professional	TC	$66.07	$81.28	$204.17