Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $121.40 / $121.40 / $121.40	Facility	26	$121.40	$121.40	$121.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.52 / $62.59 / $423.54	Professional		$52.52	$62.59	$423.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.49 / $42.59 / $139.04	Professional	26	$36.49	$42.59	$139.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.03 / $19.98 / $355.62	Professional	TC	$16.03	$19.98	$355.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.69 / $154.69 / $368.17	Professional		$154.69	$154.69	$368.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.24 / $131.24 / $138.60	Professional	26	$131.24	$131.24	$138.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.45 / $23.45 / $229.57	Professional	TC	$23.45	$23.45	$229.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $116.46 / $398.82 / $719.25	Professional		$116.46	$398.82	$719.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.05 / $116.46 / $125.00	Professional	26	$97.05	$116.46	$125.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $235.33 / $282.39 / $303.10	Professional	TC	$235.33	$282.39	$303.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $387.50 / $554.85 / $945.50	Professional		$387.50	$554.85	$945.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $157.94 / $341.60	Professional	26	$140.00	$157.94	$341.60
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $247.50 / $396.90 / $603.90	Professional	TC	$247.50	$396.90	$603.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $154.69 / $511.50 / $852.50	Professional		$154.69	$511.50	$852.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $138.60 / $169.50 / $341.60	Professional	26	$138.60	$169.50	$341.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $229.57 / $352.80 / $603.90	Professional	TC	$229.57	$352.80	$603.90
United Facility/Professional Professional Modifier Low / Median / High Price $118.32 / $441.81 / $1,685.42	Professional		$118.32	$441.81	$1,685.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.71 / $166.32 / $634.49	Professional	26	$55.71	$166.32	$634.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.61 / $275.49 / $1,050.93	Professional	TC	$62.61	$275.49	$1,050.93