Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.63 / $141.27 / $152.77	Facility	26	$57.63	$141.27	$152.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.35 / $67.80 / $194.17	Professional		$26.35	$67.80	$194.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.17 / $68.13 / $149.18	Professional	26	$17.17	$68.13	$149.18
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $480.60 / $480.60 / $529.20	Professional	50	$480.60	$480.60	$529.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.18 / $25.67 / $41.07	Professional	TC	$9.18	$25.67	$41.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $41.84 / $73.28 / $178.05	Professional		$41.84	$73.28	$178.05
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.22 / $45.40 / $85.66	Professional	26	$26.22	$45.40	$85.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.01 / $23.48 / $92.39	Professional	TC	$13.01	$23.48	$92.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $156.08 / $187.29 / $383.40	Professional		$156.08	$187.29	$383.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.25 / $95.10 / $217.96	Professional	26	$79.25	$95.10	$217.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $76.83 / $92.19 / $165.44	Professional	TC	$76.83	$92.19	$165.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.40 / $256.50 / $337.75	Professional		$141.40	$256.50	$337.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.50 / $127.16 / $171.50	Professional	26	$87.50	$127.16	$171.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.40 / $133.65 / $188.00	Professional	TC	$43.40	$133.65	$188.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.30 / $150.05 / $309.76	Professional		$60.30	$150.05	$309.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.70 / $112.00 / $159.74	Professional	26	$49.70	$112.00	$159.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $29.12 / $133.65 / $205.62	Professional	TC	$29.12	$133.65	$205.62
United Facility/Professional Professional Modifier Low / Median / High Price $47.23 / $178.05 / $302.69	Professional		$47.23	$178.05	$302.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.66 / $68.92 / $142.91	Professional	26	$22.66	$68.92	$142.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.91 / $75.30 / $157.04	Professional	TC	$16.91	$75.30	$157.04