Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $93.33	Facility	26	$74.13	$74.13	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $154.88 / $257.04	Professional		$120.23	$154.88	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $50.12 / $89.13	Professional	26	$38.02	$50.12	$89.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $109.65 / $181.97	Professional	TC	$81.28	$109.65	$181.97
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $257.04 / $269.15	Professional		$213.80	$257.04	$269.15
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $85.11 / $89.13	Professional	26	$69.18	$85.11	$89.13
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $169.82 / $181.97	Professional	TC	$144.54	$169.82	$181.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $213.80 / $371.54	Professional		$141.25	$213.80	$371.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $69.18 / $120.23	Professional	26	$46.77	$69.18	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $151.36 / $239.88	Professional	TC	$93.33	$151.36	$239.88
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $501.19 / $602.56	Professional		$501.19	$501.19	$602.56
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $162.18 / $186.21 / $186.21	Professional	26	$162.18	$186.21	$186.21
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $316.23 / $316.23 / $446.68	Professional	TC	$316.23	$316.23	$446.68
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $74.13 / $93.33	Facility	26	$74.13	$74.13	$93.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $245.47 / $309.03	Professional		$154.88	$245.47	$309.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $77.62 / $95.50	Professional	26	$47.86	$77.62	$95.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $169.82 / $208.93	Professional	TC	$107.15	$169.82	$208.93
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $89.13	Professional		$32.36	$33.11	$89.13
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Facility	26	$446.68	$446.68	$446.68
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $208.93 / $302.00	Professional		$190.55	$208.93	$302.00
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $66.07 / $89.13	Professional	26	$60.26	$66.07	$89.13
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $144.54 / $208.93	Professional	TC	$125.89	$144.54	$208.93
Select Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $141.25 / $630.96	Professional		$128.82	$141.25	$630.96
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $41.69 / $74.13	Professional	26	$41.69	$41.69	$74.13
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $87.10 / $151.36	Professional	TC	$87.10	$87.10	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $199.53 / $288.40	Professional		$144.54	$199.53	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $89.13	Professional	26	$45.71	$66.07	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $134.90 / $186.21	Professional	TC	$95.50	$134.90	$186.21