Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $254.80 / $254.80 / $478.24	Facility		$254.80	$254.80	$478.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.01 / $264.85 / $278.08	Professional		$117.01	$264.85	$278.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.57 / $100.58 / $489.60	Professional	26	$29.57	$100.58	$489.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.58 / $164.27 / $164.27	Professional	TC	$72.58	$164.27	$164.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.98 / $77.98 / $77.98	Professional		$77.98	$77.98	$77.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.85 / $37.85 / $37.85	Professional	26	$37.85	$37.85	$37.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.14 / $40.14 / $40.14	Professional	TC	$40.14	$40.14	$40.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $39.44 / $170.02 / $367.50	Professional		$39.44	$170.02	$367.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Professional	26	$61.34	$61.34	$61.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $108.66 / $108.66 / $108.66	Professional	TC	$108.66	$108.66	$108.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $103.73 / $262.50 / $384.30	Professional		$103.73	$262.50	$384.30
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.18 / $81.25 / $118.95	Professional	26	$30.18	$81.25	$118.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.55 / $177.00 / $265.35	Professional	TC	$73.55	$177.00	$265.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.98 / $257.50 / $320.05	Professional		$77.98	$257.50	$320.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.85 / $81.25 / $122.10	Professional	26	$37.85	$81.25	$122.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.14 / $176.25 / $197.95	Professional	TC	$40.14	$176.25	$197.95
United Facility/Professional Professional Modifier Low / Median / High Price $229.05 / $229.05 / $229.05	Professional		$229.05	$229.05	$229.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $96.39 / $96.39 / $96.39	Professional	26	$96.39	$96.39	$96.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $132.66 / $132.66 / $132.66	Professional	TC	$132.66	$132.66	$132.66