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 $70.79 / $89.13 / $186.21	Professional		$70.79	$89.13	$186.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $48.98 / $107.15	Professional	26	$39.81	$48.98	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $43.65 / $81.28	Professional	TC	$23.44	$43.65	$81.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $87.10 / $239.88	Professional		$74.13	$87.10	$239.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $53.70 / $151.36	Professional	26	$40.74	$53.70	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $100.00	Professional	TC	$28.18	$40.74	$100.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $194.98 / $269.15	Professional		$91.20	$194.98	$269.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $109.65 / $151.36	Professional	26	$54.95	$109.65	$151.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $87.10 / $128.82	Professional	TC	$50.12	$87.10	$128.82
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $275.42 / $371.54	Professional		$117.49	$275.42	$371.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $147.91 / $213.80	Professional	26	$70.79	$147.91	$213.80
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.31 / $95.50 / $173.78	Professional	TC	$36.31	$95.50	$173.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $102.33 / $239.88	Professional		$74.13	$102.33	$239.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $54.95 / $151.36	Professional	26	$40.74	$54.95	$151.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $38.02 / $100.00	Professional	TC	$23.99	$38.02	$100.00
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $190.55 / $288.40	Professional		$69.18	$190.55	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $120.23 / $186.21	Professional	26	$42.66	$120.23	$186.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $69.18 / $104.71	Professional	TC	$27.54	$69.18	$104.71