Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.66 / $114.82 / $120.23	Facility	26	$61.66	$114.82	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $186.21 / $489.78	Professional		$131.83	$186.21	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $51.29 / $123.03	Professional	26	$39.81	$51.29	$123.03
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $120.23 / $229.09	Professional	TC	$89.13	$120.23	$229.09
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $288.40 / $407.38	Professional		$245.47	$288.40	$407.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $89.13 / $123.03	Professional	26	$75.86	$89.13	$123.03
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $199.53 / $281.84	Professional	TC	$169.82	$199.53	$281.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $229.09 / $323.59	Professional		$173.78	$229.09	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $72.44 / $100.00	Professional	26	$50.12	$72.44	$100.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $158.49 / $223.87	Professional	TC	$120.23	$158.49	$223.87
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $616.60 / $616.60	Professional		$363.08	$616.60	$616.60
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $213.80 / $213.80 / $213.80	Professional	26	$213.80	$213.80	$213.80
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $407.38 / $407.38	Professional	TC	$147.91	$407.38	$407.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $120.23 / $125.89	Facility	26	$69.18	$120.23	$125.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $295.12 / $436.52	Professional		$165.96	$295.12	$436.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $89.13 / $114.82	Professional	26	$44.67	$89.13	$114.82
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $239.88	Professional	52	$30.20	$30.20	$239.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $208.93 / $251.19	Professional	TC	$117.49	$208.93	$251.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $104.71	Professional		$32.36	$33.11	$104.71
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $263.03 / $316.23 / $380.19	Professional		$263.03	$316.23	$380.19
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $93.33 / $117.49	Professional	26	$77.62	$93.33	$117.49
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $223.87 / $263.03	Professional	TC	$186.21	$223.87	$263.03
Select Health Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $316.23	Professional		$144.54	$144.54	$316.23
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $44.67 / $97.72	Professional	26	$44.67	$44.67	$97.72
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $104.71 / $194.98	Professional	TC	$102.33	$104.71	$194.98
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $190.55 / $323.59	Professional		$173.78	$190.55	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $56.23 / $95.50	Professional	26	$51.29	$56.23	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $131.83 / $229.09	Professional	TC	$123.03	$131.83	$229.09