Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.94 / $149.96 / $434.27	Facility	26	$108.94	$149.96	$434.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $98.70 / $175.00 / $385.38	Professional		$98.70	$175.00	$385.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.67 / $39.07 / $149.96	Professional	26	$32.67	$39.07	$149.96
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $178.89 / $402.00 / $415.77	Professional	50	$178.89	$402.00	$415.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.03 / $88.67 / $240.59	Professional	TC	$66.03	$88.67	$240.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.09 / $169.07 / $328.14	Professional		$113.09	$169.07	$328.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.71 / $66.20 / $127.82	Professional	26	$40.71	$66.20	$127.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.37 / $102.87 / $200.32	Professional	TC	$72.37	$102.87	$200.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $247.45 / $296.94 / $597.11	Professional		$247.45	$296.94	$597.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.10 / $100.92 / $231.44	Professional	26	$84.10	$100.92	$231.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $163.35 / $196.02 / $365.62	Professional	TC	$163.35	$196.02	$365.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $377.50 / $440.80 / $612.00	Professional		$377.50	$440.80	$612.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.00 / $150.80 / $208.00	Professional	26	$130.00	$150.80	$208.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $247.50 / $290.00 / $404.00	Professional	TC	$247.50	$290.00	$404.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.53 / $328.14 / $604.00	Professional		$128.53	$328.14	$604.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $74.55 / $154.50 / $233.81	Professional	26	$74.55	$154.50	$233.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $170.35 / $298.50 / $461.57	Professional	TC	$170.35	$298.50	$461.57
United Facility/Professional Professional Modifier Low / Median / High Price $144.24 / $328.15 / $557.86	Professional		$144.24	$328.15	$557.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.71 / $103.99 / $217.31	Professional	26	$55.71	$103.99	$217.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.11 / $162.16 / $320.52	Professional	TC	$114.11	$162.16	$320.52