Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.63 / $141.27 / $221.78	Facility	26	$102.63	$141.27	$221.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.03 / $138.41 / $397.02	Professional		$113.03	$138.41	$397.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.75 / $41.34 / $141.27	Professional	26	$29.75	$41.34	$141.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.28 / $103.70 / $255.75	Professional	TC	$83.28	$103.70	$255.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.04 / $171.95 / $339.20	Professional		$120.04	$171.95	$339.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.59 / $63.64 / $120.39	Professional	26	$37.59	$63.64	$120.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.45 / $109.57 / $234.03	Professional	TC	$82.45	$109.57	$234.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $253.93 / $304.70 / $609.42	Professional		$253.93	$304.70	$609.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $78.45 / $101.04 / $236.34	Professional	26	$78.45	$101.04	$236.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $175.48 / $210.57 / $392.44	Professional	TC	$175.48	$210.57	$392.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $386.25 / $455.30 / $690.00	Professional		$386.25	$455.30	$690.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $121.25 / $140.65 / $196.00	Professional	26	$121.25	$140.65	$196.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $263.75 / $314.64 / $432.00	Professional	TC	$263.75	$314.64	$432.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $146.78 / $333.82 / $628.00	Professional		$146.78	$333.82	$628.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.87 / $145.50 / $222.46	Professional	26	$68.87	$145.50	$222.46
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.22 / $318.00 / $493.56	Professional	TC	$151.22	$318.00	$493.56
United Facility/Professional Professional Modifier Low / Median / High Price $118.71 / $333.83 / $567.50	Professional		$118.71	$333.83	$567.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.17 / $120.40 / $204.68	Professional	26	$46.17	$120.40	$204.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.61 / $189.02 / $362.82	Professional	TC	$90.61	$189.02	$362.82