Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $142.10 / $142.10 / $142.10	Facility	26	$142.10	$142.10	$142.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.97 / $178.44 / $509.87	Professional		$145.97	$178.44	$509.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $49.15 / $202.18	Professional	26	$42.14	$49.15	$202.18
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.82 / $129.29 / $307.68	Professional	TC	$103.82	$129.29	$307.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.69 / $459.00 / $700.00	Professional		$199.69	$459.00	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.16 / $149.65 / $169.91	Professional	26	$68.16	$149.65	$169.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.52 / $271.94 / $331.17	Professional	TC	$131.52	$271.94	$331.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $321.85 / $386.22 / $850.41	Professional		$321.85	$386.22	$850.41
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $108.35 / $133.54 / $329.56	Professional	26	$108.35	$133.54	$329.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $198.14 / $256.17 / $520.85	Professional	TC	$198.14	$256.17	$520.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $497.50 / $542.70 / $909.65	Professional		$497.50	$542.70	$909.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $167.50 / $182.00 / $306.20	Professional	26	$167.50	$182.00	$306.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $330.00 / $361.80 / $603.45	Professional	TC	$330.00	$361.80	$603.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $188.62 / $502.50 / $863.10	Professional		$188.62	$502.50	$863.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $149.65 / $205.50 / $306.20	Professional	26	$149.65	$205.50	$306.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $301.11 / $405.00 / $603.45	Professional	TC	$301.11	$405.00	$603.45
United Facility/Professional Professional Modifier Low / Median / High Price $283.88 / $530.22 / $844.82	Professional		$283.88	$530.22	$844.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.59 / $203.88 / $324.85	Professional	26	$66.59	$203.88	$324.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.55 / $326.33 / $519.97	Professional	TC	$217.55	$326.33	$519.97