Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $124.01 / $124.01 / $124.01	Facility	26	$124.01	$124.01	$124.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $64.30 / $87.27 / $182.53	Professional		$64.30	$87.27	$182.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.69 / $46.05 / $101.40	Professional	26	$35.69	$46.05	$101.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.61 / $39.89 / $81.13	Professional	TC	$28.61	$39.89	$81.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $189.02 / $214.58 / $274.48	Professional		$189.02	$214.58	$274.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.00 / $118.55 / $159.90	Professional	26	$105.00	$118.55	$159.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.01 / $96.02 / $114.58	Professional	TC	$84.01	$96.02	$114.58
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $209.45 / $251.34 / $357.46	Professional		$209.45	$251.34	$357.46
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.13 / $126.15 / $200.13	Professional	26	$105.13	$126.15	$200.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $96.64 / $125.19 / $157.33	Professional	TC	$96.64	$125.19	$157.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.19 / $323.75 / $462.15	Professional		$120.19	$323.75	$462.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $59.41 / $162.50 / $211.58	Professional	26	$59.41	$162.50	$211.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.78 / $161.25 / $210.60	Professional	TC	$60.78	$161.25	$210.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.69 / $220.26 / $396.00	Professional		$107.69	$220.26	$396.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $65.50 / $159.90 / $255.45	Professional	26	$65.50	$159.90	$255.45
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $66.50 / $145.19 / $246.78	Professional	TC	$66.50	$145.19	$246.78
United Facility/Professional Professional Modifier Low / Median / High Price $219.58 / $224.26 / $439.16	Professional		$219.58	$224.26	$439.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.55 / $127.92 / $276.16	Professional	26	$112.55	$127.92	$276.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.66 / $111.71 / $197.88	Professional	TC	$91.66	$111.71	$197.88