Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $170.50 / $170.50 / $170.50	Facility	26	$170.50	$170.50	$170.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.23 / $111.91 / $249.08	Professional		$97.23	$111.91	$249.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.85 / $69.73 / $153.54	Professional	26	$55.85	$69.73	$153.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $31.87 / $49.26 / $95.54	Professional	TC	$31.87	$49.26	$95.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $75.47 / $140.34 / $667.55	Professional		$75.47	$140.34	$667.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.90 / $79.11 / $458.53	Professional	26	$55.90	$79.11	$458.53
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $19.57 / $50.69 / $209.02	Professional	TC	$19.57	$50.69	$209.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $269.29 / $327.99	Professional		$123.03	$269.29	$327.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.33 / $168.88 / $192.45	Professional	26	$112.33	$168.88	$192.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $66.78 / $108.35 / $140.86	Professional	TC	$66.78	$108.35	$140.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.50 / $323.75 / $546.46	Professional		$143.50	$323.75	$546.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $94.25 / $213.60 / $320.39	Professional	26	$94.25	$213.60	$320.39
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.56 / $100.00 / $213.00	Professional	TC	$42.56	$100.00	$213.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $228.95 / $482.00	Professional		$123.03	$228.95	$482.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $90.00 / $213.60 / $349.05	Professional	26	$90.00	$213.60	$349.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $40.29 / $91.20 / $203.77	Professional	TC	$40.29	$91.20	$203.77
United Facility/Professional Professional Modifier Low / Median / High Price $149.63 / $256.01 / $391.09	Professional		$149.63	$256.01	$391.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.30 / $178.06 / $302.70	Professional	26	$65.30	$178.06	$302.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.62 / $81.18 / $138.01	Professional	TC	$45.62	$81.18	$138.01