Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.16 / $131.01 / $196.52	Facility	26	$95.16	$131.01	$196.52
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.34 / $236.22 / $378.60	Professional		$112.34	$236.22	$378.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.82 / $44.45 / $131.01	Professional	26	$27.82	$44.45	$131.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $84.53 / $105.25 / $207.97	Professional	TC	$84.53	$105.25	$207.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.57 / $139.37 / $337.16	Professional		$87.57	$139.37	$337.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.89 / $59.01 / $111.60	Professional	26	$34.89	$59.01	$111.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $49.92 / $83.53 / $239.13	Professional	TC	$49.92	$83.53	$239.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $198.10 / $290.16 / $523.25	Professional		$198.10	$290.16	$523.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $87.33 / $200.99	Professional	26	$72.78	$87.33	$200.99
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.00 / $202.80 / $376.38	Professional	TC	$169.00	$202.80	$376.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $276.95 / $405.00 / $575.96	Professional		$276.95	$405.00	$575.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.50 / $130.50 / $182.00	Professional	26	$112.50	$130.50	$182.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $145.00 / $282.14 / $390.60	Professional	TC	$145.00	$282.14	$390.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $109.20 / $292.60 / $532.37	Professional		$109.20	$292.60	$532.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.19 / $135.00 / $206.57	Professional	26	$63.19	$135.00	$206.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $91.00 / $244.80 / $383.16	Professional	TC	$91.00	$244.80	$383.16
United Facility/Professional Professional Modifier Low / Median / High Price $105.45 / $255.18 / $510.36	Professional		$105.45	$255.18	$510.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.98 / $111.60 / $186.16	Professional	26	$42.98	$111.60	$186.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $85.17 / $183.01 / $331.80	Professional	TC	$85.17	$183.01	$331.80