Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $177.97	Facility	26	$79.09	$79.09	$177.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.81 / $101.35 / $371.84	Professional		$82.81	$101.35	$371.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.87 / $31.80 / $103.40	Professional	26	$22.87	$31.80	$103.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.92 / $74.64 / $284.74	Professional	TC	$59.92	$74.64	$284.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.69 / $249.63 / $465.48	Professional		$182.69	$249.63	$465.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.26 / $80.98 / $93.09	Professional	26	$38.26	$80.98	$93.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.43 / $168.65 / $378.21	Professional	TC	$144.43	$168.65	$378.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $288.49 / $354.18 / $764.61	Professional		$288.49	$354.18	$764.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.65 / $74.12 / $216.71	Professional	26	$60.65	$74.12	$216.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $222.73 / $281.39 / $686.92	Professional	TC	$222.73	$281.39	$686.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $448.75 / $504.90 / $813.54	Professional		$448.75	$504.90	$813.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.75 / $101.25 / $167.63	Professional	26	$93.75	$101.25	$167.63
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $353.75 / $403.65 / $645.91	Professional	TC	$353.75	$403.65	$645.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $169.58 / $448.75 / $813.54	Professional		$169.58	$448.75	$813.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $76.00 / $112.50 / $172.52	Professional	26	$76.00	$112.50	$172.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $279.74 / $433.50 / $660.37	Professional	TC	$279.74	$433.50	$660.37
United Facility/Professional Professional Modifier Low / Median / High Price $131.37 / $328.21 / $772.66	Professional		$131.37	$328.21	$772.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.77 / $111.72 / $187.23	Professional	26	$35.77	$111.72	$187.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.30 / $348.18 / $585.42	Professional	TC	$104.30	$348.18	$585.42