Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $57.04 / $285.18 / $570.36	Facility		$57.04	$285.18	$570.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $73.98 / $167.45 / $167.45	Professional		$73.98	$167.45	$167.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.81 / $50.63 / $347.80	Professional	26	$12.81	$50.63	$347.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.61 / $116.82 / $116.82	Professional	TC	$51.61	$116.82	$116.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $65.53 / $65.53 / $65.53	Professional		$65.53	$65.53	$65.53
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.74 / $14.74 / $14.74	Professional	26	$14.74	$14.74	$14.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.79 / $50.79 / $50.79	Professional	TC	$50.79	$50.79	$50.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $218.25 / $225.04	Professional		$19.50	$218.25	$225.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.87 / $30.87 / $30.87	Professional	26	$30.87	$30.87	$30.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.08 / $71.08 / $71.08	Professional	TC	$71.08	$71.08	$71.08
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.05 / $160.00 / $234.24	Professional		$57.05	$160.00	$234.24
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $15.09 / $41.25 / $60.39	Professional	26	$15.09	$41.25	$60.39
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $41.96 / $118.75 / $173.85	Professional	TC	$41.96	$118.75	$173.85
Providence Facility/Professional Professional Modifier Low / Median / High Price $65.53 / $161.25 / $214.60	Professional		$65.53	$161.25	$214.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $14.74 / $41.25 / $62.90	Professional	26	$14.74	$41.25	$62.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $50.79 / $120.00 / $151.69	Professional	TC	$50.79	$120.00	$151.69
United Facility/Professional Professional Modifier Low / Median / High Price $148.53 / $148.53 / $148.53	Professional		$148.53	$148.53	$148.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $48.54 / $48.54	Professional	26	$48.54	$48.54	$48.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $99.99 / $99.99 / $99.99	Professional	TC	$99.99	$99.99	$99.99