Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.15 / $27.15 / $27.15	Facility	26	$27.15	$27.15	$27.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.87 / $36.63 / $113.36	Professional		$29.87	$36.63	$113.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.92 / $9.27 / $29.91	Professional	26	$7.92	$9.27	$29.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $27.35 / $83.45	Professional	TC	$21.94	$27.35	$83.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $58.40 / $94.71 / $136.88	Professional		$58.40	$94.71	$136.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $27.96 / $32.02	Professional	26	$13.25	$27.96	$32.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.15 / $66.76 / $106.82	Professional	TC	$45.15	$66.76	$106.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.80 / $112.56 / $239.58	Professional		$93.80	$112.56	$239.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $27.33 / $74.81	Professional	26	$22.54	$27.33	$74.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.88 / $87.33 / $208.33	Professional	TC	$68.88	$87.33	$208.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $121.25 / $157.94 / $230.21	Professional		$121.25	$157.94	$230.21
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $37.70 / $58.11	Professional	26	$32.50	$37.70	$58.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.75 / $122.85 / $172.10	Professional	TC	$88.75	$122.85	$172.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $50.57 / $121.25 / $216.20	Professional		$50.57	$121.25	$216.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $39.00 / $59.02	Professional	26	$26.00	$39.00	$59.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $73.00 / $115.50 / $171.99	Professional	TC	$73.00	$115.50	$171.99
United Facility/Professional Professional Modifier Low / Median / High Price $42.45 / $99.67 / $217.69	Professional		$42.45	$99.67	$217.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.41 / $32.03 / $64.40	Professional	26	$12.41	$32.03	$64.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.41 / $77.25 / $147.34	Professional	TC	$30.41	$77.25	$147.34