Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.54 / $117.54 / $117.54	Facility	26	$117.54	$117.54	$117.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $83.73 / $101.64 / $305.18	Professional		$83.73	$101.64	$305.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $39.78 / $167.26	Professional	26	$34.07	$39.78	$167.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.65 / $61.85 / $137.91	Professional	TC	$49.65	$61.85	$137.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.42 / $229.52 / $252.07	Professional		$120.42	$229.52	$252.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.91 / $121.03 / $139.15	Professional	26	$56.91	$121.03	$139.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.51 / $90.37 / $122.50	Professional	TC	$63.51	$90.37	$122.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $192.45 / $230.94 / $508.97	Professional		$192.45	$230.94	$508.97
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.58 / $108.69 / $322.92	Professional	26	$90.58	$108.69	$322.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.23 / $122.28 / $278.58	Professional	TC	$96.23	$122.28	$278.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $251.25 / $321.30 / $453.71	Professional		$251.25	$321.30	$453.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $151.19 / $252.56	Professional	26	$140.00	$151.19	$252.56
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $114.40 / $164.70 / $206.80	Professional	TC	$114.40	$164.70	$206.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $99.10 / $251.25 / $453.71	Professional		$99.10	$251.25	$453.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $112.00 / $169.50 / $254.24	Professional	26	$112.00	$169.50	$254.24
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $110.00 / $152.50 / $201.15	Professional	TC	$110.00	$152.50	$201.15
United Facility/Professional Professional Modifier Low / Median / High Price $183.62 / $275.43 / $878.00	Professional		$183.62	$275.43	$878.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.73 / $166.80 / $537.00	Professional	26	$55.73	$166.80	$537.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $72.29 / $108.45 / $341.00	Professional	TC	$72.29	$108.45	$341.00