Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $102.33 / $102.33	Facility	26	$102.33	$102.33	$102.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $93.33 / $229.09	Professional		$57.54	$93.33	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.91 / $34.67 / $107.15	Professional	26	$22.91	$34.67	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $54.95 / $120.23	Professional	TC	$33.11	$54.95	$120.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $147.91 / $269.15	Professional		$85.11	$147.91	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $64.57 / $114.82	Professional	26	$36.31	$64.57	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $75.86 / $158.49	Professional	TC	$33.11	$75.86	$158.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $223.87 / $389.05	Professional		$158.49	$223.87	$389.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $97.72 / $162.18	Professional	26	$75.86	$97.72	$162.18
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $173.78 / $204.17 / $407.38	Professional	50	$173.78	$204.17	$407.38
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $120.23 / $173.78	Professional	TC	$81.28	$120.23	$173.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $346.74 / $549.54	Professional		$302.00	$346.74	$549.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $138.04 / $204.17	Professional	26	$125.89	$138.04	$204.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $218.78 / $346.74	Professional	TC	$169.82	$218.78	$346.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $138.04 / $269.15	Professional		$77.62	$138.04	$269.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $45.71 / $125.89	Professional	26	$30.20	$45.71	$125.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $70.79 / $165.96	Professional	TC	$41.69	$70.79	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $302.00 / $524.81	Professional		$85.11	$302.00	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $125.89 / $213.80	Professional	26	$34.67	$125.89	$213.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $181.97 / $309.03	Professional	TC	$53.70	$181.97	$309.03