Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.50 / $115.50 / $115.50	Facility	26	$115.50	$115.50	$115.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $142.36 / $146.91 / $350.54	Professional		$142.36	$146.91	$350.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.50 / $47.85 / $121.43	Professional	26	$47.50	$47.85	$121.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $94.50 / $99.40 / $229.11	Professional	TC	$94.50	$99.40	$229.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.04 / $234.66 / $440.79	Professional		$102.04	$234.66	$440.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.59 / $106.72 / $148.50	Professional	26	$45.59	$106.72	$148.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.45 / $172.72 / $297.39	Professional	TC	$56.45	$172.72	$297.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $381.70 / $458.04 / $1,002.93	Professional		$381.70	$458.04	$1,002.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $101.08 / $121.29 / $351.13	Professional	26	$101.08	$121.29	$351.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $266.60 / $336.72 / $834.15	Professional	TC	$266.60	$336.72	$834.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $323.75 / $590.00 / $684.40	Professional		$323.75	$590.00	$684.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $153.75 / $167.40 / $234.73	Professional	26	$153.75	$167.40	$234.73
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $174.00 / $433.75 / $490.05	Professional	TC	$174.00	$433.75	$490.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $170.85 / $400.82 / $608.75	Professional		$170.85	$400.82	$608.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $131.01 / $183.00 / $234.73	Professional	26	$131.01	$183.00	$234.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $170.00 / $256.50 / $453.75	Professional	TC	$170.00	$256.50	$453.75
United Facility/Professional Professional Modifier Low / Median / High Price $171.38 / $256.45 / $351.41	Professional		$171.38	$256.45	$351.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.24 / $118.80 / $123.61	Professional	26	$56.24	$118.80	$123.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.20 / $137.66 / $206.49	Professional	TC	$96.20	$137.66	$206.49