Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $140.31 / $140.31 / $140.31	Facility	26	$140.31	$140.31	$140.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.57 / $66.29 / $215.52	Professional		$55.57	$66.29	$215.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.99 / $44.36 / $160.72	Professional	26	$37.99	$44.36	$160.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.57 / $21.93 / $54.81	Professional	TC	$17.57	$21.93	$54.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.90 / $182.90 / $213.94	Professional		$182.90	$182.90	$213.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.66 / $135.66 / $160.88	Professional	26	$135.66	$135.66	$160.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.23 / $47.23 / $53.05	Professional	TC	$47.23	$47.23	$53.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.40 / $191.16 / $344.75	Professional		$87.40	$191.16	$344.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.40 / $134.88 / $144.77	Professional	26	$112.40	$134.88	$144.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.90 / $56.28 / $60.41	Professional	TC	$46.90	$56.28	$60.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $230.00 / $263.25 / $561.20	Professional		$230.00	$263.25	$561.20
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $162.50 / $184.95 / $396.50	Professional	26	$162.50	$184.95	$396.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.50 / $78.30 / $164.70	Professional	TC	$67.50	$78.30	$164.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.49 / $243.75 / $506.00	Professional		$128.49	$243.75	$506.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $160.88 / $196.50 / $396.50	Professional	26	$160.88	$196.50	$396.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $53.05 / $79.50 / $164.70	Professional	TC	$53.05	$79.50	$164.70
United Facility/Professional Professional Modifier Low / Median / High Price $85.96 / $256.70 / $979.30	Professional		$85.96	$256.70	$979.30
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.83 / $193.08 / $736.57	Professional	26	$57.83	$193.08	$736.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.13 / $63.63 / $242.73	Professional	TC	$28.13	$63.63	$242.73