Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.70 / $62.91 / $113.04	Facility	26	$45.70	$62.91	$113.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.39 / $82.79 / $240.55	Professional		$67.39	$82.79	$240.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.17 / $18.98 / $66.06	Professional	26	$16.17	$18.98	$66.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.21 / $63.78 / $164.88	Professional	TC	$51.21	$63.78	$164.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $92.55 / $174.14 / $220.79	Professional		$92.55	$174.14	$220.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.57 / $50.04 / $53.30	Professional	26	$22.57	$50.04	$53.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.97 / $122.80 / $170.75	Professional	TC	$69.97	$122.80	$170.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $146.05 / $178.56 / $378.24	Professional		$146.05	$178.56	$378.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.58 / $43.07 / $123.63	Professional	26	$35.58	$43.07	$123.63
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.34 / $135.87 / $323.38	Professional	TC	$107.34	$135.87	$323.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $205.00 / $248.40 / $373.25	Professional		$205.00	$248.40	$373.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $61.10 / $96.11	Professional	26	$55.00	$61.10	$96.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $146.25 / $190.35 / $277.14	Professional	TC	$146.25	$190.35	$277.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.48 / $205.00 / $373.25	Professional		$79.48	$205.00	$373.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.00 / $64.50 / $97.61	Professional	26	$49.00	$64.50	$97.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $126.08 / $186.00 / $290.20	Professional	TC	$126.08	$186.00	$290.20
United Facility/Professional Professional Modifier Low / Median / High Price $94.99 / $159.81 / $357.92	Professional		$94.99	$159.81	$357.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.82 / $44.37 / $107.19	Professional	26	$24.82	$44.37	$107.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.75 / $103.76 / $250.73	Professional	TC	$44.75	$103.76	$250.73