Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.12 / $142.44 / $301.93	Facility	26	$105.12	$142.44	$301.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.34 / $163.27 / $447.11	Professional		$113.34	$163.27	$447.11
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $61.36 / $159.54	Professional	26	$29.75	$61.36	$159.54
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $75.03 / $178.85 / $255.31	Professional	52	$75.03	$178.85	$255.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.59 / $112.89 / $304.67	Professional	TC	$83.59	$112.89	$304.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.27 / $189.98 / $372.15	Professional		$119.27	$189.98	$372.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.82 / $62.90 / $121.40	Professional	26	$36.82	$62.90	$121.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.45 / $127.09 / $250.76	Professional	TC	$82.45	$127.09	$250.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $283.77 / $342.54 / $683.67	Professional		$283.77	$342.54	$683.67
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.25 / $95.10 / $218.77	Professional	26	$79.25	$95.10	$218.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $206.20 / $247.44 / $464.90	Professional	TC	$206.20	$247.44	$464.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $430.00 / $511.85 / $775.55	Professional		$430.00	$511.85	$775.55
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $122.50 / $142.10 / $198.00	Professional	26	$122.50	$142.10	$198.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $306.25 / $362.60 / $498.00	Professional	TC	$306.25	$362.60	$498.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $150.47 / $372.15 / $696.00	Professional		$150.47	$372.15	$696.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.00 / $147.00 / $222.46	Professional	26	$71.00	$147.00	$222.46
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $174.66 / $373.50 / $568.97	Professional	TC	$174.66	$373.50	$568.97
United Facility/Professional Professional Modifier Low / Median / High Price $119.10 / $372.15 / $632.66	Professional		$119.10	$372.15	$632.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.23 / $97.46 / $206.38	Professional	26	$47.23	$97.46	$206.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.61 / $225.10 / $418.27	Professional	TC	$90.61	$225.10	$418.27