Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.24 / $82.24 / $82.24	Facility	26	$82.24	$82.24	$82.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.43 / $113.31 / $295.68	Professional		$92.43	$113.31	$295.68
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.17 / $27.03 / $101.89	Professional	26	$23.17	$27.03	$101.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.26 / $86.27 / $205.11	Professional	TC	$69.26	$86.27	$205.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $149.40 / $287.33 / $354.42	Professional		$149.40	$287.33	$354.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.74 / $83.02 / $97.41	Professional	26	$39.74	$83.02	$97.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.67 / $190.23 / $263.62	Professional	TC	$109.67	$190.23	$263.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $237.62 / $288.20 / $619.19	Professional		$237.62	$288.20	$619.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.08 / $77.06 / $225.42	Professional	26	$63.08	$77.06	$225.42
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $167.77 / $212.52 / $506.42	Professional	TC	$167.77	$212.52	$506.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $325.00 / $403.65 / $598.98	Professional		$325.00	$403.65	$598.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.25 / $105.30 / $176.57	Professional	26	$96.25	$105.30	$176.57
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $228.75 / $298.35 / $422.42	Professional	TC	$228.75	$298.35	$422.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.93 / $319.80 / $575.89	Professional		$128.93	$319.80	$575.89
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $77.00 / $118.50 / $176.57	Professional	26	$77.00	$118.50	$176.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $204.31 / $283.50 / $422.42	Professional	TC	$204.31	$283.50	$422.42
United Facility/Professional Professional Modifier Low / Median / High Price $134.77 / $239.42 / $578.49	Professional		$134.77	$239.42	$578.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $81.08 / $195.88	Professional	26	$36.61	$81.08	$195.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.16 / $158.34 / $375.15	Professional	TC	$98.16	$158.34	$375.15