Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.47 / $100.47 / $100.47	Facility	26	$100.47	$100.47	$100.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.40 / $210.59 / $935.00	Professional		$62.40	$210.59	$935.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.07 / $67.92 / $286.20	Professional	26	$27.07	$67.92	$286.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.34 / $75.48 / $235.46	Professional	TC	$35.34	$75.48	$235.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.50 / $186.50 / $209.77	Professional		$186.50	$186.50	$209.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.82 / $96.82 / $114.35	Professional	26	$96.82	$96.82	$114.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.68 / $89.68 / $95.41	Professional	TC	$89.68	$89.68	$95.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $99.96 / $196.02 / $353.50	Professional		$99.96	$196.02	$353.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.05 / $96.06 / $103.10	Professional	26	$80.05	$96.06	$103.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.30 / $99.96 / $107.29	Professional	TC	$83.30	$99.96	$107.29
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $236.25 / $267.30 / $576.45	Professional		$236.25	$267.30	$576.45
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $116.25 / $130.94 / $283.64	Professional	26	$116.25	$130.94	$283.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $120.00 / $136.35 / $292.80	Professional	TC	$120.00	$136.35	$292.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $133.43 / $247.50 / $519.75	Professional		$133.43	$247.50	$519.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $114.35 / $139.50 / $283.64	Professional	26	$114.35	$139.50	$283.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.41 / $142.50 / $292.80	Professional	TC	$95.41	$142.50	$292.80
United Facility/Professional Professional Modifier Low / Median / High Price $106.64 / $251.73 / $2,150.84	Professional		$106.64	$251.73	$2,150.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.39 / $91.48 / $1,144.44	Professional	26	$41.39	$91.48	$1,144.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.25 / $79.31 / $1,006.40	Professional	TC	$65.25	$79.31	$1,006.40