Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.23 / $65.23 / $65.23	Facility	26	$65.23	$65.23	$65.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.02 / $77.81 / $195.37	Professional		$63.02	$77.81	$195.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.57 / $23.58 / $71.84	Professional	26	$19.57	$23.58	$71.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.42 / $54.25 / $123.52	Professional	TC	$43.42	$54.25	$123.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $98.39 / $192.53 / $231.72	Professional		$98.39	$192.53	$231.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.40 / $68.88 / $77.89	Professional	26	$31.40	$68.88	$77.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.98 / $115.59 / $159.88	Professional	TC	$66.98	$115.59	$159.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $158.50 / $190.20 / $412.17	Professional		$158.50	$190.20	$412.17
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.13 / $61.49 / $179.79	Professional	26	$50.13	$61.49	$179.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $102.74 / $130.02 / $307.26	Professional	TC	$102.74	$130.02	$307.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $238.75 / $264.60 / $397.83	Professional		$238.75	$264.60	$397.83
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.50 / $84.50 / $140.81	Professional	26	$77.50	$84.50	$140.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $157.50 / $180.90 / $259.35	Professional	TC	$157.50	$180.90	$259.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $90.73 / $234.00 / $397.83	Professional		$90.73	$234.00	$397.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $65.00 / $94.50 / $140.81	Professional	26	$65.00	$94.50	$140.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.65 / $172.50 / $267.35	Professional	TC	$123.65	$172.50	$267.35
United Facility/Professional Professional Modifier Low / Median / High Price $94.44 / $157.60 / $332.78	Professional		$94.44	$157.60	$332.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.66 / $64.84 / $156.66	Professional	26	$28.66	$64.84	$156.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.67 / $115.58 / $232.43	Professional	TC	$63.67	$115.58	$232.43