Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.85 / $46.85 / $46.85	Facility	26	$46.85	$46.85	$46.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.49 / $60.35 / $210.23	Professional		$51.49	$60.35	$210.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $16.52 / $60.69	Professional	26	$14.36	$16.52	$60.69
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.11 / $43.83 / $130.97	Professional	TC	$37.11	$43.83	$130.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.53 / $144.72 / $218.34	Professional		$93.53	$144.72	$218.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.06 / $49.10 / $55.66	Professional	26	$23.06	$49.10	$55.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.47 / $95.63 / $167.13	Professional	TC	$70.47	$95.63	$167.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $147.86 / $180.48 / $382.86	Professional		$147.86	$180.48	$382.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.40 / $44.15 / $129.09	Professional	26	$36.40	$44.15	$129.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.65 / $136.83 / $323.38	Professional	TC	$105.65	$136.83	$323.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $206.25 / $251.10 / $371.01	Professional		$206.25	$251.10	$371.01
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.25 / $60.75 / $100.58	Professional	26	$56.25	$60.75	$100.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $148.75 / $190.35 / $270.44	Professional	TC	$148.75	$190.35	$270.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.34 / $206.25 / $365.60	Professional		$80.34	$206.25	$365.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $67.50 / $100.58	Professional	26	$46.00	$67.50	$100.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.00 / $181.50 / $270.44	Professional	TC	$113.00	$181.50	$270.44
United Facility/Professional Professional Modifier Low / Median / High Price $84.37 / $159.81 / $374.94	Professional		$84.37	$159.81	$374.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.01 / $46.35 / $123.64	Professional	26	$23.01	$46.35	$123.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.96 / $121.14 / $251.30	Professional	TC	$59.96	$121.14	$251.30