Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $153.77 / $153.77 / $153.77	Facility	26	$153.77	$153.77	$153.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.59 / $198.61 / $392.63	Professional		$95.59	$198.61	$392.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $47.77 / $176.14	Professional	26	$40.96	$47.77	$176.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.64 / $68.05 / $126.52	Professional	TC	$54.64	$68.05	$126.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.83 / $257.83 / $300.60	Professional		$257.83	$257.83	$300.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $148.62 / $148.62 / $176.94	Professional	26	$148.62	$148.62	$176.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $109.21 / $109.21 / $123.66	Professional	TC	$109.21	$109.21	$123.66
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $126.35 / $277.52 / $500.50	Professional		$126.35	$277.52	$500.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $122.10 / $146.52 / $157.26	Professional	26	$122.10	$146.52	$157.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.18 / $131.01 / $140.62	Professional	TC	$109.18	$131.01	$140.62
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $332.50 / $382.05 / $811.30	Professional		$332.50	$382.05	$811.30
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $177.50 / $201.15 / $433.10	Professional	26	$177.50	$201.15	$433.10
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $155.00 / $180.90 / $378.20	Professional	TC	$155.00	$180.90	$378.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.38 / $353.75 / $731.50	Professional		$186.38	$353.75	$731.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $176.94 / $217.50 / $433.10	Professional	26	$176.94	$217.50	$433.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.66 / $184.50 / $378.20	Professional	TC	$123.66	$184.50	$378.20
United Facility/Professional Professional Modifier Low / Median / High Price $213.83 / $360.72 / $1,376.07	Professional		$213.83	$360.72	$1,376.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.67 / $212.34 / $810.04	Professional	26	$63.67	$212.34	$810.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $98.92 / $150.16 / $566.03	Professional	TC	$98.92	$150.16	$566.03