Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.54 / $134.47 / $409.55	Facility	26	$75.54	$134.47	$409.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $78.45 / $127.20 / $218.12	Professional		$78.45	$127.20	$218.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.78 / $33.97 / $148.10	Professional	26	$24.78	$33.97	$148.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.33 / $75.83 / $98.28	Professional	TC	$30.33	$75.83	$98.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.13 / $177.73 / $241.38	Professional		$81.13	$177.73	$241.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.70 / $57.98 / $110.66	Professional	26	$34.70	$57.98	$110.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.37 / $103.80 / $176.72	Professional	TC	$16.37	$103.80	$176.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $103.50 / $155.25 / $280.00	Professional		$103.50	$155.25	$280.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.50 / $134.55 / $211.20	Professional	26	$103.50	$134.55	$211.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.37 / $31.05 / $63.36	Professional	TC	$25.37	$31.05	$63.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.00 / $313.75 / $489.47	Professional		$200.00	$313.75	$489.47
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.50 / $160.19 / $202.50	Professional	26	$112.50	$160.19	$202.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $40.00 / $189.00 / $343.00	Professional	TC	$40.00	$189.00	$343.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $83.60 / $205.97 / $489.47	Professional		$83.60	$205.97	$489.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.90 / $144.00 / $208.64	Professional	26	$63.90	$144.00	$208.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.25 / $201.25 / $398.00	Professional	TC	$41.25	$201.25	$398.00
United Facility/Professional Professional Modifier Low / Median / High Price $120.49 / $241.38 / $402.63	Professional		$120.49	$241.38	$402.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.31 / $110.68 / $188.15	Professional	26	$42.31	$110.68	$188.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $46.92 / $157.74 / $239.61	Professional	TC	$46.92	$157.74	$239.61