Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.01 / $30.01 / $30.01	Facility	26	$30.01	$30.01	$30.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.47 / $95.99 / $119.98	Professional		$33.47	$95.99	$119.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.98 / $33.04 / $57.94	Professional	26	$9.98	$33.04	$57.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.48 / $62.95 / $95.47	Professional	TC	$23.48	$62.95	$95.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.47 / $83.17 / $113.91	Professional		$48.47	$83.17	$113.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.73 / $30.85 / $35.39	Professional	26	$14.73	$30.85	$35.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $33.74 / $52.32 / $80.28	Professional	TC	$33.74	$52.32	$80.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $54.18 / $93.15 / $199.49	Professional		$54.18	$93.15	$199.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.45 / $28.26 / $80.34	Professional	26	$23.45	$28.26	$80.34
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $51.19 / $65.01 / $155.41	Professional	TC	$51.19	$65.01	$155.41
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.50 / $129.60 / $196.68	Professional		$107.50	$129.60	$196.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.25 / $42.05 / $64.81	Professional	26	$36.25	$42.05	$64.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $71.25 / $91.80 / $131.87	Professional	TC	$71.25	$91.80	$131.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $41.28 / $107.50 / $195.05	Professional		$41.28	$107.50	$195.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.55 / $43.50 / $65.83	Professional	26	$29.55	$43.50	$65.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $57.00 / $88.50 / $131.87	Professional	TC	$57.00	$88.50	$131.87
United Facility/Professional Professional Modifier Low / Median / High Price $49.81 / $83.34 / $190.05	Professional		$49.81	$83.34	$190.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.89 / $29.47 / $71.19	Professional	26	$12.89	$29.47	$71.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.83 / $58.42 / $118.58	Professional	TC	$31.83	$58.42	$118.58