Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $147.38 / $202.91 / $455.06	Facility	26	$147.38	$202.91	$455.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.46 / $151.35 / $469.73	Professional		$117.46	$151.35	$469.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $85.12 / $202.91	Professional	26	$42.60	$85.12	$202.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.87 / $93.24 / $248.76	Professional	TC	$74.87	$93.24	$248.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.69 / $196.65 / $379.65	Professional		$128.69	$196.65	$379.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.09 / $90.69 / $174.29	Professional	26	$53.09	$90.69	$174.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $75.61 / $105.96 / $205.36	Professional	TC	$75.61	$105.96	$205.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $282.23 / $338.67 / $610.75	Professional		$282.23	$338.67	$610.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.23 / $135.87 / $313.81	Professional	26	$113.23	$135.87	$313.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.00 / $202.80 / $379.91	Professional	TC	$169.00	$202.80	$379.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $432.50 / $506.05 / $741.25	Professional		$432.50	$506.05	$741.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $175.00 / $203.00 / $284.00	Professional	26	$175.00	$203.00	$284.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $255.00 / $303.05 / $420.00	Professional	TC	$255.00	$303.05	$420.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $150.30 / $379.65 / $704.00	Professional		$150.30	$379.65	$704.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $103.66 / $211.50 / $315.52	Professional	26	$103.66	$211.50	$315.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $187.46 / $306.00 / $499.80	Professional	TC	$187.46	$306.00	$499.80
United Facility/Professional Professional Modifier Low / Median / High Price $167.59 / $379.65 / $645.41	Professional		$167.59	$379.65	$645.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.27 / $174.28 / $290.70	Professional	26	$65.27	$174.28	$290.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.55 / $205.37 / $342.58	Professional	TC	$77.55	$205.37	$342.58