Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $158.49 / $158.49 / $158.49	Facility	26	$158.49	$158.49	$158.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $109.65 / $229.09	Professional		$89.13	$109.65	$229.09
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $66.07 / $141.25	Professional	26	$53.70	$66.07	$141.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $47.86 / $89.13	Professional	TC	$28.18	$47.86	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $302.00	Professional		$91.20	$112.20	$302.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $72.44 / $204.17	Professional	26	$54.95	$72.44	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.11 / $44.67 / $109.65	Professional	TC	$33.11	$44.67	$109.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $239.88 / $331.13	Professional		$117.49	$239.88	$331.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $158.49 / $257.04	Professional	26	$66.07	$158.49	$257.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $95.50 / $144.54	Professional	TC	$50.12	$95.50	$144.54
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $338.84 / $446.68	Professional		$147.91	$338.84	$446.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $199.53 / $288.40	Professional	26	$95.50	$199.53	$288.40
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $109.65 / $190.55	Professional	TC	$39.81	$109.65	$190.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $125.89 / $302.00	Professional		$91.20	$125.89	$302.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $75.86 / $204.17	Professional	26	$54.95	$75.86	$204.17
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $44.67 / $109.65	Professional	TC	$26.30	$44.67	$109.65
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $234.42 / $363.08	Professional		$87.10	$234.42	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $162.18 / $251.19	Professional	26	$57.54	$162.18	$251.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $75.86 / $114.82	Professional	TC	$30.20	$75.86	$114.82