Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $151.36 / $151.36 / $151.36	Facility	26	$151.36	$151.36	$151.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $794.33 / $1,621.81	Professional		$588.84	$794.33	$1,621.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $199.53 / $562.34	Professional	26	$114.82	$199.53	$562.34
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $199.53 / $275.42 / $588.84	Professional	52	$199.53	$275.42	$588.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $660.69 / $1,174.90	Professional	TC	$478.63	$660.69	$1,174.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $758.58 / $1,023.29 / $1,479.11	Professional		$758.58	$1,023.29	$1,479.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $154.88 / $208.93 / $295.12	Professional	26	$154.88	$208.93	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $812.83 / $1,174.90	Professional	TC	$602.56	$812.83	$1,174.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $1,479.11	Professional		$32.36	$33.11	$1,479.11
Regence BlueShield Facility/Professional Facility Modifier 26 Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Facility	26	$1,659.59	$1,659.59	$1,659.59
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $691.83 / $977.24 / $1,412.54	Professional		$691.83	$977.24	$1,412.54
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $190.55 / $275.42	Professional	26	$131.83	$190.55	$275.42
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $562.34 / $794.33 / $1,122.02	Professional	TC	$562.34	$794.33	$1,122.02
Select Health Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,000.00 / $1,479.11	Professional		$676.08	$1,000.00	$1,479.11
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $190.55 / $309.03	Professional	26	$120.23	$190.55	$309.03
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $794.33 / $1,000.00	Professional	TC	$549.54	$794.33	$1,000.00
U of Utah Health Plan Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $794.33 / $1,258.93	Professional		$173.78	$794.33	$1,258.93
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $831.76 / $1,148.15	Professional		$588.84	$831.76	$1,148.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $162.18 / $223.87	Professional	26	$112.20	$162.18	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $676.08 / $912.01	Professional	TC	$478.63	$676.08	$912.01