Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.42 / $124.42 / $124.42	Facility	26	$124.42	$124.42	$124.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.20 / $95.04 / $523.15	Professional		$70.20	$95.04	$523.15
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.43 / $46.69 / $101.74	Professional	26	$36.43	$46.69	$101.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.78 / $44.70 / $98.95	Professional	TC	$33.78	$44.70	$98.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.70 / $242.06 / $305.80	Professional		$173.70	$242.06	$305.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.29 / $119.02 / $160.54	Professional	26	$85.29	$119.02	$160.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.42 / $123.04 / $145.25	Professional	TC	$88.42	$123.04	$145.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $154.19 / $271.70 / $381.82	Professional		$154.19	$271.70	$381.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.55 / $129.06 / $201.92	Professional	26	$107.55	$129.06	$201.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $110.51 / $142.65 / $179.90	Professional	TC	$110.51	$142.65	$179.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.10 / $350.00 / $529.53	Professional		$134.10	$350.00	$529.53
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $60.32 / $166.25 / $243.39	Professional	26	$60.32	$166.25	$243.39
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.25 / $183.75 / $269.01	Professional	TC	$74.25	$183.75	$269.01
Providence Facility/Professional Professional Modifier Low / Median / High Price $118.22 / $243.65 / $529.53	Professional		$118.22	$243.65	$529.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.50 / $165.00 / $290.39	Professional	26	$66.50	$165.00	$290.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $80.65 / $189.60 / $292.48	Professional	TC	$80.65	$189.60	$292.48
United Facility/Professional Professional Modifier Low / Median / High Price $231.64 / $250.02 / $489.28	Professional		$231.64	$250.02	$489.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $114.27 / $128.44 / $277.27	Professional	26	$114.27	$128.44	$277.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.20 / $135.75 / $232.40	Professional	TC	$116.20	$135.75	$232.40