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 $99.25 / $148.08 / $249.53	Professional		$99.25	$148.08	$249.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.33 / $46.05 / $101.40	Professional	26	$36.33	$46.05	$101.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $62.92 / $105.16 / $148.13	Professional	TC	$62.92	$105.16	$148.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $305.00 / $395.71 / $507.80	Professional		$305.00	$395.71	$507.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.15 / $118.55 / $161.10	Professional	26	$108.15	$118.55	$161.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.45 / $234.62 / $399.65	Professional	TC	$186.45	$234.62	$399.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $285.45 / $342.54 / $471.94	Professional		$285.45	$342.54	$471.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.93 / $127.11 / $200.80	Professional	26	$105.93	$127.11	$200.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $166.56 / $215.43 / $271.14	Professional	TC	$166.56	$215.43	$271.14
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $173.70 / $476.55 / $678.29	Professional		$173.70	$476.55	$678.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $65.50 / $163.75 / $232.00	Professional	26	$65.50	$163.75	$232.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $122.00 / $299.70 / $447.00	Professional	TC	$122.00	$299.70	$447.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $166.05 / $310.19 / $694.80	Professional		$166.05	$310.19	$694.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $65.50 / $161.10 / $299.33	Professional	26	$65.50	$161.10	$299.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $159.46 / $293.75 / $543.83	Professional	TC	$159.46	$293.75	$543.83
United Facility/Professional Professional Modifier Low / Median / High Price $316.17 / $316.58 / $633.16	Professional		$316.17	$316.58	$633.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $112.55 / $128.88 / $219.24	Professional	26	$112.55	$128.88	$219.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $187.70 / $191.12 / $375.40	Professional	TC	$187.70	$191.12	$375.40