Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.10 / $38.38 / $473.36	Facility	26	$27.10	$38.38	$473.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.40 / $127.12 / $217.98	Professional		$119.40	$127.12	$217.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.65 / $15.74 / $33.88	Professional	26	$12.65	$15.74	$33.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.70 / $79.03 / $142.25	Professional	52	$59.70	$79.03	$142.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.66 / $114.47 / $163.66	Professional	TC	$103.66	$114.47	$163.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.72 / $134.19 / $249.06	Professional		$81.72	$134.19	$249.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.09 / $18.63 / $43.69	Professional	26	$12.09	$18.63	$43.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.64 / $111.63 / $205.36	Professional	TC	$69.64	$111.63	$205.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $189.78 / $237.75 / $454.80	Professional		$189.78	$237.75	$454.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $28.30 / $33.96 / $84.37	Professional	26	$28.30	$33.96	$84.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $169.83 / $203.79 / $377.34	Professional	TC	$169.83	$203.79	$377.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $271.08 / $333.45 / $446.40	Professional		$271.08	$333.45	$446.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $37.40 / $47.25 / $64.53	Professional	26	$37.40	$47.25	$64.53
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $232.20 / $286.20 / $379.44	Professional	TC	$232.20	$286.20	$379.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $105.21 / $241.08 / $439.25	Professional		$105.21	$241.08	$439.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.57 / $52.20 / $69.26	Professional	26	$22.57	$52.20	$69.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $125.79 / $306.00 / $397.75	Professional	TC	$125.79	$306.00	$397.75
United Facility/Professional Professional Modifier Low / Median / High Price $173.50 / $199.24 / $377.09	Professional		$173.50	$199.24	$377.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $17.01 / $34.96 / $66.17	Professional	26	$17.01	$34.96	$66.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.99 / $164.28 / $310.92	Professional	TC	$143.99	$164.28	$310.92