Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $126.94 / $174.73 / $174.74	Facility	26	$126.94	$174.73	$174.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.43 / $240.09 / $450.29	Professional		$93.43	$240.09	$450.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $73.20 / $166.13	Professional	26	$36.61	$73.20	$166.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $56.82 / $89.94 / $242.93	Professional	TC	$56.82	$89.94	$242.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.67 / $182.57 / $349.42	Professional		$112.67	$182.57	$349.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.97 / $78.67 / $149.10	Professional	26	$44.97	$78.67	$149.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $67.70 / $103.90 / $200.32	Professional	TC	$67.70	$103.90	$200.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $165.78 / $315.39 / $617.50	Professional		$165.78	$315.39	$617.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.05 / $116.46 / $271.79	Professional	26	$97.05	$116.46	$271.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $153.77 / $198.93 / $374.56	Professional	TC	$153.77	$198.93	$374.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $403.75 / $471.25 / $660.00	Professional		$403.75	$471.25	$660.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $150.00 / $174.00 / $250.00	Professional	26	$150.00	$174.00	$250.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $248.75 / $292.89 / $410.00	Professional	TC	$248.75	$292.89	$410.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $138.51 / $349.42 / $638.00	Professional		$138.51	$349.42	$638.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.75 / $180.00 / $274.67	Professional	26	$88.75	$180.00	$274.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $183.82 / $298.50 / $468.43	Professional	TC	$183.82	$298.50	$468.43
United Facility/Professional Professional Modifier Low / Median / High Price $126.01 / $331.00 / $559.08	Professional		$126.01	$331.00	$559.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.77 / $149.10 / $238.56	Professional	26	$56.77	$149.10	$238.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $74.06 / $204.99 / $320.52	Professional	TC	$74.06	$204.99	$320.52