Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $143.94 / $143.94 / $143.94	Facility	26	$143.94	$143.94	$143.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.06 / $179.45 / $301.62	Professional		$145.06	$179.45	$301.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $18.38 / $158.53	Professional	26	$15.71	$18.38	$158.53
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.36 / $143.09 / $161.07	Professional	TC	$129.36	$143.09	$161.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $145.53 / $267.55 / $341.35	Professional		$145.53	$267.55	$341.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.28 / $70.09 / $170.30	Professional	26	$32.28	$70.09	$170.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.43 / $167.03 / $212.81	Professional	TC	$75.43	$167.03	$212.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $232.08 / $278.49 / $630.91	Professional		$232.08	$278.49	$630.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.98 / $135.32 / $394.62	Professional	26	$109.98	$135.32	$394.62
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $115.81 / $146.52 / $351.00	Professional	TC	$115.81	$146.52	$351.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $291.25 / $390.15 / $612.50	Professional		$291.25	$390.15	$612.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.70 / $183.60 / $267.14	Professional	26	$63.70	$183.60	$267.14
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $188.75 / $231.00 / $392.00	Professional	TC	$188.75	$231.00	$392.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $122.21 / $298.39 / $583.10	Professional		$122.21	$298.39	$583.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.74 / $170.00 / $265.51	Professional	26	$54.74	$170.00	$265.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $184.80 / $249.00 / $392.00	Professional	TC	$184.80	$249.00	$392.00
United Facility/Professional Professional Modifier Low / Median / High Price $250.02 / $337.33 / $678.39	Professional		$250.02	$337.33	$678.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.46 / $136.25 / $292.92	Professional	26	$48.46	$136.25	$292.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.30 / $200.43 / $335.90	Professional	TC	$132.30	$200.43	$335.90