Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.98 / $78.76 / $234.24	Facility	26	$69.98	$78.76	$234.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.43 / $149.43 / $288.63	Professional		$115.43	$149.43	$288.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.45 / $34.06 / $351.56	Professional	26	$28.45	$34.06	$351.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.57 / $115.43 / $168.55	Professional	TC	$86.57	$115.43	$168.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.71 / $190.51 / $310.37	Professional		$114.71	$190.51	$310.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.14 / $36.79 / $91.08	Professional	26	$25.14	$36.79	$91.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.57 / $115.68 / $246.20	Professional	TC	$89.57	$115.68	$246.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.10 / $283.35 / $407.44	Professional		$177.10	$283.35	$407.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $59.03 / $70.83 / $165.59	Professional	26	$59.03	$70.83	$165.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $175.40 / $212.52 / $397.03	Professional	TC	$175.40	$212.52	$397.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $347.50 / $399.60 / $518.94	Professional		$347.50	$399.60	$518.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.84 / $98.55 / $135.78	Professional	26	$78.84	$98.55	$135.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $256.25 / $301.05 / $396.34	Professional	TC	$256.25	$301.05	$396.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $132.05 / $305.62 / $510.40	Professional		$132.05	$305.62	$510.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.94 / $109.50 / $166.81	Professional	26	$46.94	$109.50	$166.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.35 / $309.00 / $419.95	Professional	TC	$139.35	$309.00	$419.95
United Facility/Professional Professional Modifier Low / Median / High Price $159.18 / $238.76 / $387.99	Professional		$159.18	$238.76	$387.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.00 / $72.86 / $118.40	Professional	26	$39.00	$72.86	$118.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.87 / $165.90 / $280.00	Professional	TC	$110.87	$165.90	$280.00