Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.47 / $98.47 / $98.47	Facility	26	$98.47	$98.47	$98.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.14 / $96.27 / $228.24	Professional		$79.14	$96.27	$228.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.80 / $36.00 / $108.44	Professional	26	$29.80	$36.00	$108.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.35 / $61.46 / $119.79	Professional	TC	$49.35	$61.46	$119.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $84.57 / $150.31 / $305.37	Professional		$84.57	$150.31	$305.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.95 / $63.93 / $125.22	Professional	26	$35.95	$63.93	$125.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.63 / $86.38 / $180.15	Professional	TC	$48.63	$86.38	$180.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $180.33 / $216.39 / $442.13	Professional		$180.33	$216.39	$442.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.63 / $93.15 / $210.59	Professional	26	$77.63	$93.15	$210.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.70 / $123.24 / $231.59	Professional	TC	$102.70	$123.24	$231.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $278.75 / $353.60 / $544.00	Professional		$278.75	$353.60	$544.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.00 / $141.00 / $204.00	Professional	26	$120.00	$141.00	$204.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $158.75 / $221.00 / $340.00	Professional	TC	$158.75	$221.00	$340.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $105.11 / $268.80 / $540.64	Professional		$105.11	$268.80	$540.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.42 / $153.00 / $227.97	Professional	26	$72.42	$153.00	$227.97
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $152.88 / $243.60 / $388.45	Professional	TC	$152.88	$243.60	$388.45
United Facility/Professional Professional Modifier Low / Median / High Price $106.81 / $269.00 / $519.14	Professional		$106.81	$269.00	$519.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.64 / $149.91 / $212.88	Professional	26	$45.64	$149.91	$212.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.59 / $180.15 / $306.26	Professional	TC	$64.59	$180.15	$306.26