Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $91.55 / $91.55 / $91.55	Facility	26	$91.55	$91.55	$91.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.01 / $85.40 / $204.77	Professional		$70.01	$85.40	$204.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.28 / $34.21 / $100.82	Professional	26	$26.28	$34.21	$100.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.97 / $102.39 / $139.81	Professional	52	$39.97	$102.39	$139.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.74 / $54.49 / $103.95	Professional	TC	$43.74	$54.49	$103.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $73.73 / $131.63 / $235.44	Professional		$73.73	$131.63	$235.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.23 / $55.04 / $106.97	Professional	26	$31.23	$55.04	$106.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.51 / $76.59 / $132.15	Professional	TC	$42.51	$76.59	$132.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $164.98 / $197.97 / $400.47	Professional		$164.98	$197.97	$400.47
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $87.33 / $195.69	Professional	26	$72.78	$87.33	$195.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.20 / $110.64 / $204.78	Professional	TC	$92.20	$110.64	$204.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $233.75 / $295.80 / $420.18	Professional		$233.75	$295.80	$420.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $111.25 / $127.60 / $178.00	Professional	26	$111.25	$127.60	$178.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $137.19 / $165.30 / $223.50	Professional	TC	$137.19	$165.30	$223.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $90.74 / $215.67 / $390.35	Professional		$90.74	$215.67	$390.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.25 / $132.00 / $199.76	Professional	26	$57.25	$132.00	$199.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $100.46 / $165.00 / $249.70	Professional	TC	$100.46	$165.00	$249.70
United Facility/Professional Professional Modifier Low / Median / High Price $75.97 / $207.43 / $352.62	Professional		$75.97	$207.43	$352.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.67 / $106.98 / $181.86	Professional	26	$37.67	$106.98	$181.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.46 / $100.45 / $170.76	Professional	TC	$49.46	$100.45	$170.76