Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $99.54 / $133.76 / $333.90	Facility	26	$99.54	$133.76	$333.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.59 / $217.85 / $347.53	Professional		$82.59	$217.85	$347.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.64 / $80.09 / $133.76	Professional	26	$27.64	$80.09	$133.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $68.44 / $176.53	Professional	TC	$54.95	$68.44	$176.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.21 / $134.12 / $259.82	Professional		$89.21	$134.12	$259.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.11 / $59.07 / $113.97	Professional	26	$34.11	$59.07	$113.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.10 / $75.04 / $151.66	Professional	TC	$55.10	$75.04	$151.66
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $121.50 / $234.84 / $443.70	Professional		$121.50	$234.84	$443.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.40 / $89.28 / $205.28	Professional	26	$74.40	$89.28	$205.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.28 / $145.56 / $270.88	Professional	TC	$89.28	$145.56	$270.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $297.50 / $350.90 / $529.70	Professional		$297.50	$350.90	$529.70
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $115.00 / $133.40 / $186.00	Professional	26	$115.00	$133.40	$186.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $181.25 / $217.50 / $296.00	Professional	TC	$181.25	$217.50	$296.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.52 / $259.82 / $482.00	Professional		$107.52	$259.82	$482.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.45 / $138.00 / $208.84	Professional	26	$67.45	$138.00	$208.84
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $132.86 / $217.50 / $338.18	Professional	TC	$132.86	$217.50	$338.18
United Facility/Professional Professional Modifier Low / Median / High Price $115.03 / $259.83 / $441.70	Professional		$115.03	$259.83	$441.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.31 / $91.18 / $182.36	Professional	26	$45.31	$91.18	$182.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.45 / $145.85 / $247.94	Professional	TC	$65.45	$145.85	$247.94