Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.78 / $35.78 / $35.78	Facility	26	$35.78	$35.78	$35.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $43.78 / $53.72 / $155.46	Professional		$43.78	$53.72	$155.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.61 / $12.41 / $39.40	Professional	26	$10.61	$12.41	$39.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.15 / $41.31 / $116.07	Professional	TC	$33.15	$41.31	$116.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.70 / $132.44 / $190.89	Professional		$79.70	$132.44	$190.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.17 / $38.52 / $43.16	Professional	26	$17.17	$38.52	$43.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.53 / $93.93 / $151.44	Professional	TC	$62.53	$93.93	$151.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.84 / $154.29 / $325.88	Professional		$125.84	$154.29	$325.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.50 / $33.71 / $98.61	Professional	26	$27.50	$33.71	$98.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $95.81 / $121.29 / $286.58	Professional	TC	$95.81	$121.29	$286.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.75 / $214.65 / $324.08	Professional		$173.75	$214.65	$324.08
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $42.50 / $46.80 / $78.23	Professional	26	$42.50	$46.80	$78.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $130.00 / $168.75 / $245.70	Professional	TC	$130.00	$168.75	$245.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $68.86 / $173.75 / $310.20	Professional		$68.86	$173.75	$310.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.00 / $52.50 / $78.23	Professional	26	$36.00	$52.50	$78.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.00 / $165.00 / $245.00	Professional	TC	$104.00	$165.00	$245.00
United Facility/Professional Professional Modifier Low / Median / High Price $65.27 / $136.61 / $309.10	Professional		$65.27	$136.61	$309.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.39 / $35.95 / $86.83	Professional	26	$16.39	$35.95	$86.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.34 / $107.40 / $215.93	Professional	TC	$49.34	$107.40	$215.93