Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.86 / $100.86 / $100.86	Facility	26	$100.86	$100.86	$100.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.48 / $169.06 / $565.87	Professional		$118.48	$169.06	$565.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.53 / $36.19 / $155.49	Professional	26	$30.53	$36.19	$155.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $132.86 / $293.13	Professional	TC	$87.95	$132.86	$293.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.03 / $193.94 / $469.40	Professional		$110.03	$193.94	$469.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.31 / $61.20 / $118.78	Professional	26	$38.31	$61.20	$118.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.86 / $125.72 / $350.62	Professional	TC	$69.86	$125.72	$350.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $461.54 / $571.55 / $1,124.23	Professional		$461.54	$571.55	$1,124.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.63 / $93.15 / $217.81	Professional	26	$77.63	$93.15	$217.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $369.95 / $478.41 / $906.42	Professional	TC	$369.95	$478.41	$906.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $366.80 / $736.25 / $991.80	Professional		$366.80	$736.25	$991.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $118.75 / $137.75 / $192.00	Professional	26	$118.75	$137.75	$192.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $231.00 / $616.25 / $820.80	Professional	TC	$231.00	$616.25	$820.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $197.24 / $446.96 / $852.33	Professional		$197.24	$446.96	$852.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.45 / $142.50 / $215.65	Professional	26	$67.45	$142.50	$215.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $152.06 / $426.02 / $798.00	Professional	TC	$152.06	$426.02	$798.00
United Facility/Professional Professional Modifier Low / Median / High Price $166.68 / $518.09 / $782.99	Professional		$166.68	$518.09	$782.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.08 / $118.78 / $201.92	Professional	26	$47.08	$118.78	$201.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $125.59 / $280.50 / $561.00	Professional	TC	$125.59	$280.50	$561.00