Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.32 / $157.37 / $404.50	Facility	26	$114.32	$157.37	$404.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $82.68 / $235.79 / $423.15	Professional		$82.68	$235.79	$423.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.34 / $66.69 / $150.79	Professional	26	$33.34	$66.69	$150.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $49.35 / $61.46 / $140.44	Professional	TC	$49.35	$61.46	$140.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.86 / $142.63 / $272.02	Professional		$91.86	$142.63	$272.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.08 / $71.20 / $135.25	Professional	26	$41.08	$71.20	$135.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.78 / $74.92 / $136.77	Professional	TC	$50.78	$74.92	$136.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $207.83 / $249.39 / $509.49	Professional		$207.83	$249.39	$509.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.33 / $104.79 / $244.77	Professional	26	$87.33	$104.79	$244.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.50 / $144.60 / $264.72	Professional	TC	$120.50	$144.60	$264.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $315.00 / $365.40 / $512.00	Professional		$315.00	$365.40	$512.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $135.00 / $156.60 / $224.00	Professional	26	$135.00	$156.60	$224.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $175.00 / $201.55 / $288.00	Professional	TC	$175.00	$201.55	$288.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $106.31 / $265.35 / $490.00	Professional		$106.31	$265.35	$490.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $80.23 / $163.50 / $249.70	Professional	26	$80.23	$163.50	$249.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $126.49 / $204.00 / $317.80	Professional	TC	$126.49	$204.00	$317.80
United Facility/Professional Professional Modifier Low / Median / High Price $123.08 / $272.02 / $462.44	Professional		$123.08	$272.02	$462.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.88 / $108.20 / $225.61	Professional	26	$53.88	$108.20	$225.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.94 / $136.78 / $232.51	Professional	TC	$63.94	$136.78	$232.51