Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.07 / $66.07 / $66.07	Facility	26	$66.07	$66.07	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $645.65	Professional		$147.91	$213.80	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $28.84 / $56.23	Professional	26	$20.89	$28.84	$56.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $186.21 / $316.23	Professional	TC	$123.03	$186.21	$316.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $295.12 / $478.63	Professional		$158.49	$295.12	$478.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.99 / $44.67 / $79.43	Professional	26	$23.99	$44.67	$79.43
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $239.88 / $398.11	Professional	TC	$134.90	$239.88	$398.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $457.09 / $676.08	Professional		$275.42	$457.09	$676.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $72.44 / $117.49	Professional	26	$38.90	$72.44	$117.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $380.19 / $562.34	Professional	TC	$239.88	$380.19	$562.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $537.03 / $645.65 / $870.96	Professional		$537.03	$645.65	$870.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $128.82	Professional	26	$77.62	$95.50	$128.82
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $467.74 / $549.54 / $741.31	Professional	TC	$467.74	$549.54	$741.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $295.12 / $478.63	Professional		$158.49	$295.12	$478.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $33.11 / $85.11	Professional	26	$23.44	$33.11	$85.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $190.55 / $426.58	Professional	TC	$131.83	$190.55	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $380.19 / $831.76	Professional		$295.12	$380.19	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $69.18 / $147.91	Professional	26	$34.67	$69.18	$147.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $316.23 / $676.08	Professional	TC	$263.03	$316.23	$676.08