Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $103.78 / $142.86 / $142.86	Facility	26	$103.78	$142.86	$142.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $99.89 / $117.76 / $334.73	Professional		$99.89	$117.76	$334.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.21 / $35.77 / $131.47	Professional	26	$31.21	$35.77	$131.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.67 / $81.98 / $220.44	Professional	TC	$68.67	$81.98	$220.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.69 / $282.66 / $403.23	Professional		$162.69	$282.66	$403.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.53 / $107.21 / $122.75	Professional	26	$50.53	$107.21	$122.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.16 / $175.44 / $288.95	Professional	TC	$112.16	$175.44	$288.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $262.00 / $314.39 / $688.93	Professional		$262.00	$314.39	$688.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.05 / $97.81 / $283.73	Professional	26	$80.05	$97.81	$283.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $172.74 / $218.34 / $530.47	Professional	TC	$172.74	$218.34	$530.47
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $382.50 / $444.15 / $683.91	Professional		$382.50	$444.15	$683.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.75 / $143.55 / $221.27	Professional	26	$123.75	$143.55	$221.27
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $258.75 / $311.85 / $465.75	Professional	TC	$258.75	$311.85	$465.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $145.35 / $382.50 / $683.91	Professional		$145.35	$382.50	$683.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $99.00 / $148.50 / $224.73	Professional	26	$99.00	$148.50	$224.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $207.00 / $310.50 / $473.00	Professional	TC	$207.00	$310.50	$473.00
United Facility/Professional Professional Modifier Low / Median / High Price $110.43 / $275.62 / $665.97	Professional		$110.43	$275.62	$665.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $102.18 / $246.86	Professional	26	$52.54	$102.18	$246.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.53 / $208.40 / $419.11	Professional	TC	$117.53	$208.40	$419.11