Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $166.68 / $166.68 / $166.68	Facility	26	$166.68	$166.68	$166.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.50 / $197.23 / $243.73	Professional		$162.50	$197.23	$243.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.29 / $76.39 / $136.30	Professional	26	$65.29	$76.39	$136.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.11 / $125.43 / $131.93	Professional	TC	$86.11	$125.43	$131.93
Cigna Facility/Professional Professional Modifier Low / Median / High Price $113.72 / $197.98 / $389.62	Professional		$113.72	$197.98	$389.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.84 / $88.32 / $217.54	Professional	26	$59.84	$88.32	$217.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.88 / $86.85 / $192.16	Professional	TC	$53.88	$86.85	$192.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $283.02 / $339.63 / $709.17	Professional		$283.02	$339.63	$709.17
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $142.33 / $170.79 / $397.18	Professional	26	$142.33	$170.79	$397.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $140.69 / $168.84 / $312.04	Professional	TC	$140.69	$168.84	$312.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $379.50 / $473.85 / $640.50	Professional		$379.50	$473.85	$640.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $190.08 / $237.60 / $322.08	Professional	26	$190.08	$237.60	$322.08
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $185.90 / $236.25 / $318.42	Professional	TC	$185.90	$236.25	$318.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $144.47 / $339.08 / $628.25	Professional		$144.47	$339.08	$628.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $111.60 / $259.50 / $336.70	Professional	26	$111.60	$259.50	$336.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.86 / $247.80 / $338.55	Professional	TC	$117.86	$247.80	$338.55
United Facility/Professional Professional Modifier Low / Median / High Price $248.32 / $311.70 / $589.94	Professional		$248.32	$311.70	$589.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.00 / $174.04 / $329.40	Professional	26	$89.00	$174.04	$329.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $128.72 / $146.88 / $260.54	Professional	TC	$128.72	$146.88	$260.54