Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $173.78 / $173.78 / $173.78	Facility	26	$173.78	$173.78	$173.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $117.49 / $251.19	Professional		$97.72	$117.49	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $72.44 / $151.36	Professional	26	$58.88	$72.44	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $52.48 / $95.50	Professional	TC	$30.90	$52.48	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $123.03 / $323.59	Professional		$97.72	$123.03	$323.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $79.43 / $223.87	Professional	26	$60.26	$79.43	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $50.12 / $117.49	Professional	TC	$37.15	$50.12	$117.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $263.03 / $354.81	Professional		$123.03	$263.03	$354.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $158.49 / $218.78	Professional	26	$74.13	$158.49	$218.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $102.33 / $165.96	Professional	TC	$53.70	$102.33	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $371.54 / $478.63	Professional		$162.18	$371.54	$478.63
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $213.80 / $316.23	Professional	26	$102.33	$213.80	$316.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $120.23 / $204.17	Professional	TC	$43.65	$120.23	$204.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $134.90 / $323.59	Professional		$97.72	$134.90	$323.59
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $223.87	Professional	26	$60.26	$81.28	$223.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.84 / $50.12 / $117.49	Professional	TC	$28.84	$50.12	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $257.04 / $389.05	Professional		$95.50	$257.04	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $177.83 / $275.42	Professional	26	$61.66	$177.83	$275.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $81.28 / $123.03	Professional	TC	$32.36	$81.28	$123.03