Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.08 / $94.08 / $94.08	Facility	26	$94.08	$94.08	$94.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $62.80 / $92.39 / $210.65	Professional		$62.80	$92.39	$210.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.06 / $34.39 / $76.92	Professional	26	$27.06	$34.39	$76.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $55.94 / $133.72	Professional	TC	$33.03	$55.94	$133.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.88 / $242.34 / $289.07	Professional		$161.88	$242.34	$289.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.88 / $89.99 / $121.03	Professional	26	$77.88	$89.99	$121.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.01 / $152.35 / $168.04	Professional	TC	$84.01	$152.35	$168.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $245.83 / $294.99 / $400.65	Professional		$245.83	$294.99	$400.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.68 / $98.01 / $152.78	Professional	26	$81.68	$98.01	$152.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $152.26 / $196.98 / $247.87	Professional	TC	$152.26	$196.98	$247.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $143.55 / $368.00 / $494.76	Professional		$143.55	$368.00	$494.76
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.16 / $123.48 / $178.87	Professional	26	$46.16	$123.48	$178.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $90.45 / $211.20 / $330.38	Professional	TC	$90.45	$211.20	$330.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $117.80 / $257.24 / $472.50	Professional		$117.80	$257.24	$472.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.50 / $121.20 / $196.95	Professional	26	$50.50	$121.20	$196.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $86.36 / $187.50 / $321.30	Professional	TC	$86.36	$187.50	$321.30
United Facility/Professional Professional Modifier Low / Median / High Price $204.14 / $231.26 / $462.52	Professional		$204.14	$231.26	$462.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $86.79 / $96.82 / $209.02	Professional	26	$86.79	$96.82	$209.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $108.28 / $134.44 / $228.67	Professional	TC	$108.28	$134.44	$228.67