Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.63 / $62.63 / $62.63	Facility	26	$62.63	$62.63	$62.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $86.40 / $289.92	Professional		$73.73	$86.40	$289.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.16 / $20.81 / $68.97	Professional	26	$18.16	$20.81	$68.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.57 / $65.59 / $220.95	Professional	TC	$55.57	$65.59	$220.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $148.04 / $205.91 / $352.47	Professional		$148.04	$205.91	$352.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.43 / $62.73 / $72.81	Professional	26	$30.43	$62.73	$72.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.61 / $143.18 / $282.92	Professional	TC	$117.61	$143.18	$282.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $237.78 / $286.26 / $603.67	Professional		$237.78	$286.26	$603.67
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.53 / $59.00 / $170.24	Professional	26	$48.53	$59.00	$170.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $180.09 / $228.03 / $543.21	Professional	TC	$180.09	$228.03	$543.21
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $315.00 / $399.60 / $585.57	Professional		$315.00	$399.60	$585.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.00 / $87.00 / $131.87	Professional	26	$75.00	$87.00	$131.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $240.00 / $319.95 / $453.71	Professional	TC	$240.00	$319.95	$453.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.28 / $305.62 / $564.40	Professional		$128.28	$305.62	$564.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.00 / $88.50 / $136.19	Professional	26	$58.00	$88.50	$136.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $185.65 / $304.50 / $453.71	Professional	TC	$185.65	$304.50	$453.71
United Facility/Professional Professional Modifier Low / Median / High Price $94.55 / $230.70 / $557.41	Professional		$94.55	$230.70	$557.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.77 / $60.62 / $146.46	Professional	26	$30.77	$60.62	$146.46
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.68 / $204.35 / $410.58	Professional	TC	$89.68	$204.35	$410.58