Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $131.83 / $154.88	Facility	26	$114.82	$131.83	$154.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $120.23 / $407.38	Professional		$75.86	$120.23	$407.38
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $47.86 / $141.25	Professional	26	$28.84	$47.86	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $69.18 / $158.49	Professional	TC	$45.71	$69.18	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $181.97 / $295.12	Professional		$100.00	$181.97	$295.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $70.79 / $123.03	Professional	26	$39.81	$70.79	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $100.00 / $165.96	Professional	TC	$43.65	$100.00	$165.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $123.03 / $154.88	Facility	26	$114.82	$123.03	$154.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $269.15 / $407.38	Professional		$128.82	$269.15	$407.38
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $109.65 / $177.83	Professional	26	$52.48	$109.65	$177.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $154.88 / $229.09	Professional	TC	$85.11	$154.88	$229.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $398.11 / $602.56	Professional		$346.74	$398.11	$602.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $151.36 / $234.42	Professional	26	$134.90	$151.36	$234.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $239.88 / $363.08	Professional	TC	$208.93	$239.88	$363.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $169.82 / $288.40	Professional		$91.20	$169.82	$288.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $51.29 / $131.83	Professional	26	$34.67	$51.29	$131.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $77.62 / $177.83	Professional	TC	$54.95	$77.62	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $295.12 / $501.19	Professional		$100.00	$295.12	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $131.83 / $223.87	Professional	26	$38.02	$131.83	$223.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $169.82 / $281.84	Professional	TC	$63.10	$169.82	$281.84