Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $85.31 / $85.31 / $85.31	Facility	26	$85.31	$85.31	$85.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.73 / $111.21 / $382.43	Professional		$90.73	$111.21	$382.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $28.43 / $93.96	Professional	26	$24.26	$28.43	$93.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.45 / $82.78 / $288.47	Professional	TC	$66.45	$82.78	$288.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $187.63 / $288.70 / $483.00	Professional		$187.63	$288.70	$483.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.71 / $88.64 / $101.28	Professional	26	$42.71	$88.64	$101.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.91 / $200.07 / $386.65	Professional	TC	$144.91	$200.07	$386.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $295.20 / $362.94 / $788.87	Professional		$295.20	$362.94	$788.87
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.13 / $80.55 / $236.21	Professional	26	$67.13	$80.55	$236.21
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.50 / $282.39 / $696.09	Professional	TC	$223.50	$282.39	$696.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $397.50 / $522.45 / $775.55	Professional		$397.50	$522.45	$775.55
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.75 / $120.35 / $187.74	Professional	26	$103.75	$120.35	$187.74
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $293.75 / $409.05 / $587.80	Professional	TC	$293.75	$409.05	$587.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $167.57 / $397.50 / $709.20	Professional		$167.57	$397.50	$709.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $82.00 / $126.00 / $189.66	Professional	26	$82.00	$126.00	$189.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $253.59 / $394.50 / $587.80	Professional	TC	$253.59	$394.50	$587.80
United Facility/Professional Professional Modifier Low / Median / High Price $162.22 / $304.75 / $681.89	Professional		$162.22	$304.75	$681.89
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $84.30 / $203.67	Professional	26	$36.61	$84.30	$203.67
United Facility/Professional Professional Modifier TC Low / Median / High Price $106.11 / $251.70 / $461.45	Professional	TC	$106.11	$251.70	$461.45