Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.10 / $86.01 / $202.07	Facility	26	$38.10	$86.01	$202.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $79.23 / $96.97 / $218.54	Professional		$79.23	$96.97	$218.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.46 / $30.93 / $130.80	Professional	26	$23.46	$30.93	$130.80
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $39.61 / $88.16 / $130.80	Professional	52	$39.61	$88.16	$130.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.30 / $69.59 / $114.22	Professional	TC	$48.30	$69.59	$114.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.29 / $122.78 / $243.63	Professional		$85.29	$122.78	$243.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.72 / $49.18 / $101.81	Professional	26	$21.72	$49.18	$101.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.77 / $73.25 / $141.81	Professional	TC	$40.77	$73.25	$141.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $96.80 / $168.84 / $304.50	Professional		$96.80	$168.84	$304.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.50 / $78.59 / $181.45	Professional	26	$65.50	$78.59	$181.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.20 / $90.24 / $161.85	Professional	TC	$75.20	$90.24	$161.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $217.50 / $313.75 / $449.92	Professional		$217.50	$313.75	$449.92
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.25 / $115.50 / $157.77	Professional	26	$96.25	$115.50	$157.77
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $116.25 / $170.19 / $311.89	Professional	TC	$116.25	$170.19	$311.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $82.93 / $213.75 / $449.92	Professional		$82.93	$213.75	$449.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.09 / $119.35 / $180.95	Professional	26	$50.09	$119.35	$180.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $105.60 / $211.50 / $354.00	Professional	TC	$105.60	$211.50	$354.00
United Facility/Professional Professional Modifier Low / Median / High Price $82.93 / $194.90 / $406.38	Professional		$82.93	$194.90	$406.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $101.80 / $173.06	Professional	26	$36.61	$101.80	$173.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.56 / $142.06 / $241.10	Professional	TC	$58.56	$142.06	$241.10