Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	26	$30.90	$30.90	$30.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $85.11 / $275.42	Professional		$54.95	$85.11	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $20.89 / $93.33	Professional	26	$15.85	$20.89	$93.33
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $229.09 / $229.09 / $245.47	Professional	50	$229.09	$229.09	$245.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $46.77 / $81.28	Professional	TC	$38.02	$46.77	$81.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $117.49	Professional		$91.20	$112.20	$117.49
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $35.48 / $37.15	Professional	26	$27.54	$35.48	$37.15
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $77.62 / $81.28	Professional	TC	$61.66	$77.62	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $97.72 / $123.03	Professional		$60.26	$97.72	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $28.84 / $36.31	Professional	26	$19.95	$28.84	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $69.18 / $87.10	Professional	TC	$40.74	$69.18	$87.10
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $30.90 / $30.90	Facility	26	$30.90	$30.90	$30.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $112.20 / $138.04	Professional		$61.66	$112.20	$138.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $32.36 / $40.74	Professional	26	$18.20	$32.36	$40.74
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $229.09 / $229.09 / $245.47	Professional	50	$229.09	$229.09	$245.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $81.28 / $97.72	Professional	TC	$41.69	$81.28	$97.72
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 Professional Modifier Low / Median / High Price $67.61 / $91.20 / $147.91	Professional		$67.61	$91.20	$147.91
Regence BlueShield Facility/Professional Professional Modifier 26 Low / Median / High Price $19.50 / $26.30 / $40.74	Professional	26	$19.50	$26.30	$40.74
Regence BlueShield Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $64.57 / $104.71	Professional	TC	$47.86	$64.57	$104.71
Select Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $60.26 / $107.15	Professional		$60.26	$60.26	$107.15
Select Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $17.78 / $33.11	Professional	26	$17.78	$17.78	$33.11
Select Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $42.66 / $72.44	Professional	TC	$42.66	$42.66	$72.44
United Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $87.10 / $120.23	Professional		$64.57	$87.10	$120.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $26.30 / $37.15	Professional	26	$19.05	$26.30	$37.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $58.88 / $85.11	Professional	TC	$44.67	$58.88	$85.11