Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.61 / $64.61 / $64.61	Facility	26	$64.61	$64.61	$64.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.07 / $179.84 / $241.40	Professional		$123.07	$179.84	$241.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.93 / $30.04 / $59.44	Professional	26	$15.93	$30.04	$59.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.95 / $149.79 / $192.90	Professional	TC	$106.95	$149.79	$192.90
Cigna Facility/Professional Professional Modifier Low / Median / High Price $119.34 / $189.13 / $381.51	Professional		$119.34	$189.13	$381.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.05 / $34.86 / $85.78	Professional	26	$18.05	$34.86	$85.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.36 / $168.71 / $295.73	Professional	TC	$95.36	$168.71	$295.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $287.67 / $355.17 / $692.15	Professional		$287.67	$355.17	$692.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $66.00 / $153.91	Professional	26	$55.00	$66.00	$153.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $240.98 / $289.17 / $538.23	Professional	TC	$240.98	$289.17	$538.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $400.68 / $500.85 / $669.78	Professional		$400.68	$500.85	$669.78
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $64.61 / $93.15 / $125.48	Professional	26	$64.61	$93.15	$125.48
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $325.08 / $410.20 / $545.34	Professional	TC	$325.08	$410.20	$545.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $167.20 / $362.60 / $650.67	Professional		$167.20	$362.60	$650.67
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.86 / $102.00 / $134.68	Professional	26	$34.86	$102.00	$134.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $168.71 / $437.80 / $565.66	Professional	TC	$168.71	$437.80	$565.66
United Facility/Professional Professional Modifier Low / Median / High Price $164.51 / $305.22 / $577.66	Professional		$164.51	$305.22	$577.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.64 / $68.62 / $137.24	Professional	26	$22.64	$68.62	$137.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $200.65 / $236.60 / $473.20	Professional	TC	$200.65	$236.60	$473.20