Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $117.49 / $117.49 / $117.49	Facility	26	$117.49	$117.49	$117.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $93.33 / $194.98	Professional		$75.86	$93.33	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $48.98 / $107.15	Professional	26	$40.74	$48.98	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $46.77 / $89.13	Professional	TC	$27.54	$46.77	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $93.33 / $245.47	Professional		$77.62	$93.33	$245.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $151.36	Professional	26	$40.74	$56.23	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.62 / $45.71 / $109.65	Professional	TC	$31.62	$45.71	$109.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $208.93 / $281.84	Professional		$93.33	$208.93	$281.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $109.65 / $190.55	Professional	26	$50.12	$109.65	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $95.50 / $144.54	Professional	TC	$48.98	$95.50	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $295.12 / $389.05	Professional		$123.03	$295.12	$389.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $147.91 / $218.78	Professional	26	$72.44	$147.91	$218.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $104.71 / $190.55	Professional	TC	$39.81	$104.71	$190.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $109.65 / $245.47	Professional		$77.62	$109.65	$245.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $56.23 / $151.36	Professional	26	$40.74	$56.23	$151.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $42.66 / $109.65	Professional	TC	$26.30	$42.66	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $194.98 / $295.12	Professional		$72.44	$194.98	$295.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $120.23 / $199.53	Professional	26	$42.66	$120.23	$199.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $75.86 / $114.82	Professional	TC	$30.90	$75.86	$114.82