Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $151.76 / $262.70 / $320.67	Facility	26	$151.76	$262.70	$320.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.31 / $272.42 / $565.59	Professional		$193.31	$272.42	$565.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.82 / $72.75 / $262.70	Professional	26	$43.82	$72.75	$262.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $162.19 / $162.19 / $162.19	Professional	50	$162.19	$162.19	$162.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.61 / $221.14 / $313.70	Professional	TC	$177.61	$221.14	$313.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $197.70 / $476.19 / $700.00	Professional		$197.70	$476.19	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.64 / $153.62 / $210.00	Professional	26	$70.64	$153.62	$210.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.05 / $313.08 / $490.00	Professional	TC	$127.05	$313.08	$490.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $319.43 / $383.31 / $845.02	Professional		$319.43	$383.31	$845.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.23 / $139.21 / $343.64	Professional	26	$113.23	$139.21	$343.64
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $191.37 / $247.44 / $501.38	Professional	TC	$191.37	$247.44	$501.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $493.75 / $632.50 / $974.46	Professional		$493.75	$632.50	$974.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $175.00 / $189.00 / $317.37	Professional	26	$175.00	$189.00	$317.37
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $318.75 / $453.75 / $657.09	Professional	TC	$318.75	$453.75	$657.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $497.50 / $974.46	Professional		$187.43	$497.50	$974.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $144.00 / $213.00 / $317.37	Professional	26	$144.00	$213.00	$317.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $322.50 / $453.75 / $732.00	Professional	TC	$322.50	$453.75	$732.00
United Facility/Professional Professional Modifier Low / Median / High Price $367.57 / $566.13 / $961.04	Professional		$367.57	$566.13	$961.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.52 / $210.78 / $335.84	Professional	26	$74.52	$210.78	$335.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $236.89 / $355.35 / $649.83	Professional	TC	$236.89	$355.35	$649.83