Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $724.44 / $1,000.00 / $2,344.23	Professional		$724.44	$1,000.00	$2,344.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $186.21 / $575.44	Professional	26	$107.15	$186.21	$575.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $588.84 / $794.33 / $1,412.54	Professional	TC	$588.84	$794.33	$1,412.54
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Facility	26	$1,584.89	$1,584.89	$1,584.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,318.26 / $1,380.38	Professional		$1,096.48	$1,318.26	$1,380.38
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $181.97 / $218.78 / $229.09	Professional	26	$181.97	$218.78	$229.09
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $912.01 / $1,096.48 / $1,148.15	Professional	TC	$912.01	$1,096.48	$1,148.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,230.27 / $1,905.46	Professional		$891.25	$1,230.27	$1,905.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $204.17 / $323.59	Professional	26	$138.04	$204.17	$323.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $1,023.29 / $1,621.81	Professional	TC	$741.31	$1,023.29	$1,621.81
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $2,238.72 / $2,344.23 / $2,344.23	Professional		$2,238.72	$2,344.23	$2,344.23
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $407.38 / $407.38 / $512.86	Professional	26	$407.38	$407.38	$512.86
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,737.80 / $1,949.84 / $1,949.84	Professional	TC	$1,737.80	$1,949.84	$1,949.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $912.01 / $1,513.56 / $1,995.26	Professional		$912.01	$1,513.56	$1,995.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $223.87 / $331.13	Professional	26	$134.90	$223.87	$331.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $758.58 / $1,288.25 / $1,513.56	Professional	TC	$758.58	$1,288.25	$1,513.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $457.09	Professional		$32.36	$33.11	$457.09
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Facility	26	$1,584.89	$1,584.89	$1,584.89
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,230.27 / $1,905.46	Professional		$1,023.29	$1,230.27	$1,905.46
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $151.36 / $181.97 / $346.74	Professional	26	$151.36	$181.97	$346.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $870.96 / $1,047.13 / $1,621.81	Professional	TC	$870.96	$1,047.13	$1,621.81
Select Health Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $933.25 / $2,398.83	Professional		$741.31	$933.25	$2,398.83
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $112.20 / $181.97	Professional	26	$112.20	$112.20	$181.97
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $630.96 / $912.01	Professional	TC	$630.96	$630.96	$912.01
United Facility/Professional Professional Modifier Low / Median / High Price $870.96 / $1,230.27 / $1,778.28	Professional		$870.96	$1,230.27	$1,778.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $213.80 / $331.13	Professional	26	$131.83	$213.80	$331.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $1,000.00 / $1,479.11	Professional	TC	$741.31	$1,000.00	$1,479.11