Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.93 / $56.33 / $56.33	Facility	26	$40.93	$56.33	$56.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $46.93 / $55.07 / $217.73	Professional		$46.93	$55.07	$217.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.78 / $14.74 / $45.07	Professional	26	$12.78	$14.74	$45.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.14 / $40.33 / $129.11	Professional	TC	$34.14	$40.33	$129.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.58 / $131.46 / $210.06	Professional		$91.58	$131.46	$210.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.61 / $43.47 / $48.23	Professional	26	$20.61	$43.47	$48.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.97 / $87.99 / $164.72	Professional	TC	$70.97	$87.99	$164.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $147.00 / $176.61 / $369.05	Professional		$147.00	$176.61	$369.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.35 / $38.99 / $112.78	Professional	26	$32.35	$38.99	$112.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $108.88 / $137.79 / $323.38	Professional	TC	$108.88	$137.79	$323.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $188.75 / $245.70 / $350.90	Professional		$188.75	$245.70	$350.90
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $58.00 / $87.17	Professional	26	$50.00	$58.00	$87.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.75 / $191.70 / $263.73	Professional	TC	$138.75	$191.70	$263.73
Providence Facility/Professional Professional Modifier Low / Median / High Price $78.00 / $188.75 / $340.12	Professional		$78.00	$188.75	$340.12
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.00 / $58.50 / $88.53	Professional	26	$41.00	$58.50	$88.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $108.23 / $177.00 / $263.73	Professional	TC	$108.23	$177.00	$263.73
United Facility/Professional Professional Modifier Low / Median / High Price $123.98 / $133.47 / $335.55	Professional		$123.98	$133.47	$335.55
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $40.15 / $96.99	Professional	26	$14.07	$40.15	$96.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.97 / $119.42 / $231.44	Professional	TC	$58.97	$119.42	$231.44