Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $106.67 / $106.67 / $106.67	Facility	26	$106.67	$106.67	$106.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $200.98 / $240.93 / $413.13	Professional		$200.98	$240.93	$413.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.75 / $63.40 / $117.25	Professional	26	$48.75	$63.40	$117.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $152.22 / $178.34 / $246.64	Professional	TC	$152.22	$178.34	$246.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.30 / $252.61 / $492.72	Professional		$151.30	$252.61	$492.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $72.45 / $139.49	Professional	26	$38.90	$72.45	$139.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.40 / $180.16 / $353.23	Professional	TC	$112.40	$180.16	$353.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $376.53 / $459.00 / $900.62	Professional		$376.53	$459.00	$900.62
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.58 / $108.69 / $251.59	Professional	26	$90.58	$108.69	$251.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $291.93 / $350.31 / $649.03	Professional	TC	$291.93	$350.31	$649.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $507.60 / $642.60 / $863.04	Professional		$507.60	$642.60	$863.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $122.04 / $151.19 / $204.96	Professional	26	$122.04	$151.19	$204.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $385.56 / $491.40 / $652.86	Professional	TC	$385.56	$491.40	$652.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $217.56 / $465.50 / $831.72	Professional		$217.56	$465.50	$831.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.70 / $168.00 / $217.41	Professional	26	$79.70	$168.00	$217.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $180.16 / $507.50 / $675.32	Professional	TC	$180.16	$507.50	$675.32
United Facility/Professional Professional Modifier Low / Median / High Price $311.45 / $394.18 / $746.04	Professional		$311.45	$394.18	$746.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $81.18 / $111.60 / $211.22	Professional	26	$81.18	$111.60	$211.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.00 / $282.58 / $534.82	Professional	TC	$190.00	$282.58	$534.82