Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $157.01 / $157.01 / $157.01	Facility	26	$157.01	$157.01	$157.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $90.04 / $103.93 / $230.71	Professional		$90.04	$103.93	$230.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.45 / $63.15 / $141.38	Professional	26	$51.45	$63.15	$141.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.10 / $46.15 / $89.34	Professional	TC	$28.10	$46.15	$89.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $69.22 / $130.06 / $616.80	Professional		$69.22	$130.06	$616.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.23 / $72.84 / $422.34	Professional	26	$51.23	$72.84	$422.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.98 / $44.40 / $194.48	Professional	TC	$17.98	$44.40	$194.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $113.53 / $249.08 / $303.81	Professional		$113.53	$249.08	$303.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.39 / $155.44 / $177.14	Professional	26	$103.39	$155.44	$177.14
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.28 / $101.08 / $131.40	Professional	TC	$62.28	$101.08	$131.40
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.99 / $298.75 / $505.52	Professional		$132.99	$298.75	$505.52
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $86.80 / $195.60 / $300.12	Professional	26	$86.80	$195.60	$300.12
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.76 / $80.40 / $199.50	Professional	TC	$38.76	$80.40	$199.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $113.53 / $209.95 / $447.00	Professional		$113.53	$209.95	$447.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.00 / $182.60 / $319.80	Professional	26	$83.00	$182.60	$319.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $36.85 / $80.40 / $190.86	Professional	TC	$36.85	$80.40	$190.86
United Facility/Professional Professional Modifier Low / Median / High Price $127.88 / $239.54 / $407.22	Professional		$127.88	$239.54	$407.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.25 / $164.02 / $278.83	Professional	26	$58.25	$164.02	$278.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.33 / $75.52 / $128.38	Professional	TC	$40.33	$75.52	$128.38