Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.03 / $123.03 / $123.03	Facility	26	$123.03	$123.03	$123.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $173.78 / $346.74	Professional		$114.82	$173.78	$346.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $54.95 / $117.49	Professional	26	$38.02	$54.95	$117.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $117.49 / $257.04	Professional	TC	$75.86	$117.49	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $234.42 / $436.52	Professional		$125.89	$234.42	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $89.13 / $147.91	Professional	26	$43.65	$89.13	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $128.82 / $275.42	Professional	TC	$83.18	$128.82	$275.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $398.11 / $602.56	Professional		$275.42	$398.11	$602.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $134.90 / $218.78	Professional	26	$87.10	$134.90	$218.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $269.15 / $380.19	Professional	TC	$177.83	$269.15	$380.19
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $549.54 / $741.31	Professional		$436.52	$549.54	$741.31
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $141.25 / $169.82 / $239.88	Professional	26	$141.25	$169.82	$239.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $380.19 / $501.19	Professional	TC	$295.12	$380.19	$501.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $257.04 / $426.58	Professional		$134.90	$257.04	$426.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $60.26 / $158.49	Professional	26	$42.66	$60.26	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $128.82 / $295.12	Professional	TC	$89.13	$128.82	$295.12
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $346.74 / $436.52	Professional		$251.19	$346.74	$436.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $128.82 / $158.49	Professional	26	$67.61	$128.82	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $218.78 / $275.42	Professional	TC	$169.82	$218.78	$275.42