Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $122.26 / $122.26 / $137.61	Facility	26	$122.26	$122.26	$137.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $166.89 / $303.25 / $336.77	Professional		$166.89	$303.25	$336.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.63 / $110.09 / $122.26	Professional	26	$49.63	$110.09	$122.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.26 / $193.16 / $214.51	Professional	TC	$117.26	$193.16	$214.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $124.59 / $205.71 / $432.12	Professional		$124.59	$205.71	$432.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.11 / $64.27 / $159.59	Professional	26	$44.11	$64.27	$159.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.87 / $127.10 / $272.52	Professional	TC	$83.87	$127.10	$272.52
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $327.50 / $393.00 / $790.78	Professional		$327.50	$393.00	$790.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.50 / $124.20 / $288.36	Professional	26	$103.50	$124.20	$288.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $222.04 / $268.80 / $502.48	Professional	TC	$222.04	$268.80	$502.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $407.00 / $552.15 / $742.14	Professional		$407.00	$552.15	$742.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $138.24 / $171.45 / $234.24	Professional	26	$138.24	$171.45	$234.24
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $266.20 / $380.70 / $504.06	Professional	TC	$266.20	$380.70	$504.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $155.86 / $400.82 / $711.62	Professional		$155.86	$400.82	$711.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $82.23 / $185.60 / $246.27	Professional	26	$82.23	$185.60	$246.27
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $127.10 / $386.10 / $521.40	Professional	TC	$127.10	$386.10	$521.40
United Facility/Professional Professional Modifier Low / Median / High Price $267.42 / $345.70 / $561.76	Professional		$267.42	$345.70	$561.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.16 / $127.66 / $207.45	Professional	26	$67.16	$127.66	$207.45
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.33 / $218.04 / $354.31	Professional	TC	$187.33	$218.04	$354.31