Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $107.15 / $107.15 / $107.15	Facility	26	$107.15	$107.15	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $93.33 / $257.04	Professional		$64.57	$93.33	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $38.90 / $114.82	Professional	26	$25.70	$38.90	$114.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $52.48 / $141.25	Professional	TC	$38.02	$52.48	$141.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $218.78 / $295.12	Professional		$169.82	$218.78	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $107.15 / $123.03	Professional	26	$64.57	$107.15	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $134.90 / $181.97	Professional	TC	$112.20	$134.90	$181.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $213.80 / $338.84	Professional		$134.90	$213.80	$338.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $95.50 / $239.88	Professional	26	$52.48	$95.50	$239.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $125.89 / $288.40	Professional	TC	$77.62	$125.89	$288.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $331.13 / $512.86	Professional		$288.40	$331.13	$512.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $131.83 / $218.78	Professional	26	$123.03	$131.83	$218.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $165.96 / $199.53 / $302.00	Professional	TC	$165.96	$199.53	$302.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $169.82 / $229.09	Professional		$77.62	$169.82	$229.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $64.57 / $123.03	Professional	26	$28.18	$64.57	$123.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $63.10 / $144.54	Professional	TC	$44.67	$63.10	$144.54
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $213.80 / $446.68	Professional		$204.17	$213.80	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $102.33 / $208.93	Professional	26	$85.11	$102.33	$208.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $131.83 / $229.09	Professional	TC	$107.15	$131.83	$229.09