Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $190.55 / $257.04	Facility	26	$169.82	$190.55	$257.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $851.14 / $1,584.89	Professional		$588.84	$851.14	$1,584.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $154.88 / $380.19	Professional	26	$112.20	$154.88	$380.19
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $199.53 / $213.80	Professional	52	$199.53	$199.53	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $691.83 / $1,230.27	Professional	TC	$467.74	$691.83	$1,230.27
BCBS Facility/Professional Facility Modifier 26 Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility	26	$1,778.28	$1,778.28	$1,778.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $891.25 / $1,202.26 / $1,288.25	Professional		$891.25	$1,202.26	$1,288.25
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $223.87 / $251.19	Professional	26	$186.21	$223.87	$251.19
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $676.08 / $891.25 / $1,047.13	Professional	TC	$676.08	$891.25	$1,047.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $707.95 / $1,000.00 / $1,288.25	Professional		$707.95	$1,000.00	$1,288.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $204.17 / $251.19	Professional	26	$144.54	$204.17	$251.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $794.33 / $1,023.29	Professional	TC	$549.54	$794.33	$1,023.29
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $186.21 / $213.80 / $257.04	Facility	26	$186.21	$213.80	$257.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $1,230.27 / $1,412.54	Professional		$660.69	$1,230.27	$1,412.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $223.87 / $302.00	Professional	26	$125.89	$223.87	$302.00
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $199.53 / $213.80	Professional	52	$199.53	$199.53	$213.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $1,023.29 / $1,174.90	Professional	TC	$537.03	$1,023.29	$1,174.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,778.28 / $1,778.28 / $1,778.28	Facility	26	$1,778.28	$1,778.28	$1,778.28
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $954.99 / $1,412.54	Professional		$660.69	$954.99	$1,412.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $173.78 / $269.15	Professional	26	$125.89	$173.78	$269.15
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $524.81 / $776.25 / $1,148.15	Professional	TC	$524.81	$776.25	$1,148.15
Select Health Facility/Professional Professional Modifier Low / Median / High Price $660.69 / $724.44 / $2,398.83	Professional		$660.69	$724.44	$2,398.83
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $120.23 / $218.78	Professional	26	$120.23	$120.23	$218.78
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $537.03 / $537.03 / $891.25	Professional	TC	$537.03	$537.03	$891.25
United Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $977.24 / $1,258.93	Professional		$676.08	$977.24	$1,258.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $186.21 / $251.19	Professional	26	$131.83	$186.21	$251.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $776.25 / $1,000.00	Professional	TC	$549.54	$776.25	$1,000.00