Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.93 / $38.93 / $38.93	Facility	26	$38.93	$38.93	$38.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.77 / $47.41 / $139.37	Professional		$38.77	$47.41	$139.37
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.21 / $13.07 / $45.77	Professional	26	$11.21	$13.07	$45.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $34.33 / $96.50	Professional	TC	$27.55	$34.33	$96.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.25 / $117.85 / $169.10	Professional		$70.25	$117.85	$169.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.64 / $40.04 / $46.88	Professional	26	$18.64	$40.04	$46.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.61 / $77.80 / $126.12	Professional	TC	$51.61	$77.80	$126.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $113.23 / $135.87 / $294.31	Professional		$113.23	$135.87	$294.31
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $29.93 / $36.68 / $107.25	Professional	26	$29.93	$36.68	$107.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.09 / $99.96 / $240.57	Professional	TC	$77.09	$99.96	$240.57
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $153.75 / $191.70 / $288.32	Professional		$153.75	$191.70	$288.32
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.25 / $49.95 / $84.93	Professional	26	$46.25	$49.95	$84.93
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $106.25 / $141.75 / $203.39	Professional	TC	$106.25	$141.75	$203.39
Providence Facility/Professional Professional Modifier Low / Median / High Price $61.30 / $153.75 / $274.42	Professional		$61.30	$153.75	$274.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $57.00 / $84.93	Professional	26	$37.43	$57.00	$84.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.00 / $136.50 / $202.91	Professional	TC	$85.00	$136.50	$202.91
United Facility/Professional Professional Modifier Low / Median / High Price $63.80 / $138.25 / $276.87	Professional		$63.80	$138.25	$276.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $39.03 / $94.27	Professional	26	$16.98	$39.03	$94.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.51 / $89.35 / $173.91	Professional	TC	$43.51	$89.35	$173.91