Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.93 / $112.93 / $123.31	Facility	26	$112.93	$112.93	$123.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.21 / $185.43 / $203.97	Professional		$93.21	$185.43	$203.97
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $59.29 / $100.83	Professional	26	$42.14	$59.29	$100.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $45.30 / $75.70 / $95.54	Professional	52	$45.30	$75.70	$95.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.07 / $95.13 / $131.86	Professional	TC	$51.07	$95.13	$131.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.46 / $363.28 / $368.88	Professional		$239.46	$363.28	$368.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $118.57 / $143.25 / $159.93	Professional	26	$118.57	$143.25	$159.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $120.89 / $203.35 / $225.64	Professional	TC	$120.89	$203.35	$225.64
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $232.90 / $279.48 / $393.82	Professional		$232.90	$279.48	$393.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.33 / $125.19 / $200.34	Professional	26	$104.33	$125.19	$200.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $118.85 / $154.29 / $193.48	Professional	TC	$118.85	$154.29	$193.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $213.30 / $387.45 / $578.40	Professional		$213.30	$387.45	$578.40
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $78.30 / $174.15 / $236.07	Professional	26	$78.30	$174.15	$236.07
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.60 / $214.65 / $311.25	Professional	TC	$110.60	$214.65	$311.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $135.00 / $242.60 / $603.54	Professional		$135.00	$242.60	$603.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $86.00 / $165.30 / $339.30	Professional	26	$86.00	$165.30	$339.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $138.60 / $231.00 / $600.60	Professional	TC	$138.60	$231.00	$600.60
United Facility/Professional Professional Modifier Low / Median / High Price $235.42 / $290.62 / $900.00	Professional		$235.42	$290.62	$900.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $110.83 / $127.94 / $369.00	Professional	26	$110.83	$127.94	$369.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.59 / $162.68 / $531.00	Professional	TC	$124.59	$162.68	$531.00