Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.84 / $101.66 / $334.32	Facility	26	$73.84	$101.66	$334.32
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.24 / $90.58 / $212.43	Professional		$56.24	$90.58	$212.43
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.92 / $32.53 / $101.66	Professional	26	$16.92	$32.53	$101.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.02 / $70.40 / $98.56	Professional	TC	$30.02	$70.40	$98.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.69 / $97.98 / $167.53	Professional		$63.69	$97.98	$167.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.29 / $46.08 / $87.02	Professional	26	$21.29	$46.08	$87.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $47.42 / $87.52	Professional	TC	$32.79	$47.42	$87.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $121.30 / $145.56 / $297.00	Professional		$121.30	$145.56	$297.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.68 / $71.16 / $170.28	Professional	26	$60.68	$71.16	$170.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.96 / $77.64 / $140.38	Professional	TC	$63.96	$77.64	$140.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $172.50 / $212.80 / $306.20	Professional		$172.50	$212.80	$306.20
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $75.59 / $101.50 / $142.00	Professional	26	$75.59	$101.50	$142.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $83.75 / $106.65 / $140.00	Professional	TC	$83.75	$106.65	$140.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $65.08 / $154.19 / $276.00	Professional		$65.08	$154.19	$276.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.99 / $105.00 / $156.63	Professional	26	$48.99	$105.00	$156.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.24 / $100.50 / $153.10	Professional	TC	$58.24	$100.50	$153.10
United Facility/Professional Professional Modifier Low / Median / High Price $90.49 / $154.19 / $257.22	Professional		$90.49	$154.19	$257.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.47 / $87.03 / $145.16	Professional	26	$25.47	$87.03	$145.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.60 / $81.06 / $112.05	Professional	TC	$53.60	$81.06	$112.05