Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $112.04 / $143.54	Facility	26	$81.40	$112.04	$143.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $86.06 / $133.00 / $315.67	Professional		$86.06	$133.00	$315.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.64 / $29.88 / $89.64	Professional	26	$24.64	$29.88	$89.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.40 / $103.12 / $226.03	Professional	TC	$61.40	$103.12	$226.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.93 / $160.34 / $341.10	Professional		$97.93	$160.34	$341.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.60 / $50.21 / $96.40	Professional	26	$30.60	$50.21	$96.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.34 / $121.10 / $244.70	Professional	TC	$67.34	$121.10	$244.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $255.23 / $310.52 / $606.86	Professional		$255.23	$310.52	$606.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.28 / $74.73 / $173.32	Professional	26	$62.28	$74.73	$173.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $196.50 / $235.80 / $433.54	Professional	TC	$196.50	$235.80	$433.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $349.70 / $432.00 / $617.60	Professional		$349.70	$432.00	$617.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.25 / $111.65 / $158.00	Professional	26	$96.25	$111.65	$158.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $261.80 / $328.05 / $454.41	Professional	TC	$261.80	$328.05	$454.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $111.95 / $330.40 / $614.66	Professional		$111.95	$330.40	$614.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.09 / $117.00 / $177.06	Professional	26	$56.09	$117.00	$177.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $158.46 / $332.50 / $452.20	Professional	TC	$158.46	$332.50	$452.20
United Facility/Professional Professional Modifier Low / Median / High Price $130.12 / $341.10 / $579.87	Professional		$130.12	$341.10	$579.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.94 / $96.40 / $163.88	Professional	26	$36.94	$96.40	$163.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $93.18 / $228.78 / $408.18	Professional	TC	$93.18	$228.78	$408.18