Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $229.09 / $229.09 / $229.09	Facility	26	$229.09	$229.09	$229.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $173.78 / $275.42	Professional		$128.82	$173.78	$275.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $81.28 / $138.04	Professional	26	$70.79	$81.28	$138.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $89.13 / $128.82	Professional	TC	$54.95	$89.13	$128.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $407.38 / $537.03	Professional		$363.08	$407.38	$537.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $213.80 / $288.40	Professional	26	$186.21	$213.80	$288.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $199.53 / $251.19	Professional	TC	$173.78	$199.53	$251.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $436.52 / $724.44	Professional		$162.18	$436.52	$724.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.28 / $234.42 / $398.11	Professional	26	$81.28	$234.42	$398.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $204.17 / $323.59	Professional	TC	$81.28	$204.17	$323.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $645.65 / $851.14	Professional		$331.13	$645.65	$851.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $158.49 / $323.59 / $416.87	Professional	26	$158.49	$323.59	$416.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $323.59 / $407.38	Professional	TC	$173.78	$323.59	$407.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $398.11 / $501.19	Professional		$181.97	$398.11	$501.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $144.54 / $288.40	Professional	26	$77.62	$144.54	$288.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $144.54 / $251.19	Professional	TC	$85.11	$144.54	$251.19
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $436.52 / $933.25	Professional		$138.04	$436.52	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $229.09 / $501.19	Professional	26	$107.15	$229.09	$501.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $204.17 / $436.52	Professional	TC	$81.28	$204.17	$436.52