Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $129.24 / $225.90 / $430.45	Facility	26	$129.24	$225.90	$430.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $226.80 / $278.51 / $642.11	Professional		$226.80	$278.51	$642.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.17 / $62.84 / $200.80	Professional	26	$49.17	$62.84	$200.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $256.85 / $256.85 / $279.95	Professional	52	$256.85	$256.85	$279.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.61 / $221.14 / $379.20	Professional	TC	$177.61	$221.14	$379.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $195.33 / $471.34 / $700.00	Professional		$195.33	$471.34	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.33 / $138.96 / $210.00	Professional	26	$61.33	$138.96	$210.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.00 / $332.37 / $490.00	Professional	TC	$134.00	$332.37	$490.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $315.38 / $378.45 / $977.08	Professional		$315.38	$378.45	$977.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.85 / $119.70 / $294.25	Professional	26	$97.85	$119.70	$294.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $201.89 / $261.02 / $532.57	Professional	TC	$201.89	$261.02	$532.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $487.50 / $548.79 / $876.12	Professional		$487.50	$548.79	$876.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $151.25 / $163.35 / $272.67	Professional	26	$151.25	$163.35	$272.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $336.25 / $378.00 / $603.45	Professional	TC	$336.25	$378.00	$603.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $183.38 / $492.50 / $827.40	Professional		$183.38	$492.50	$827.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $145.19 / $183.00 / $272.67	Professional	26	$145.19	$183.00	$272.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $332.40 / $421.00 / $603.45	Professional	TC	$332.40	$421.00	$603.45
United Facility/Professional Professional Modifier Low / Median / High Price $337.78 / $506.67 / $957.00	Professional		$337.78	$506.67	$957.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $77.47 / $180.36 / $340.00	Professional	26	$77.47	$180.36	$340.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.54 / $326.31 / $617.00	Professional	TC	$217.54	$326.31	$617.00