Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.23 / $56.23 / $56.23	Facility	26	$56.23	$56.23	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $125.89 / $295.12	Professional		$75.86	$125.89	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $23.99 / $70.79	Professional	26	$14.13	$23.99	$70.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $104.71 / $229.09	Professional	TC	$60.26	$104.71	$229.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $281.84 / $354.81	Professional		$194.98	$281.84	$354.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $57.54 / $64.57	Professional	26	$34.67	$57.54	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $257.04 / $295.12	Professional	TC	$218.78	$257.04	$295.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $263.03 / $398.11	Professional		$131.83	$263.03	$398.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $52.48 / $128.82	Professional	26	$25.12	$52.48	$128.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $213.80 / $309.03	Professional	TC	$109.65	$213.80	$309.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $398.11 / $588.84	Professional		$309.03	$398.11	$588.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $77.62 / $120.23	Professional	26	$66.07	$77.62	$120.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $331.13 / $489.78	Professional	TC	$239.88	$331.13	$489.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $190.55 / $281.84	Professional		$89.13	$190.55	$281.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.14 / $34.67 / $64.57	Professional	26	$15.14	$34.67	$64.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $95.50 / $257.04	Professional	TC	$67.61	$95.50	$257.04
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $234.42 / $489.78	Professional		$134.90	$234.42	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $53.70 / $112.20	Professional	26	$45.71	$53.70	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $181.97 / $380.19	Professional	TC	$109.65	$181.97	$380.19