Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.09 / $42.09 / $42.09	Facility	26	$42.09	$42.09	$42.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $39.97 / $48.84 / $142.84	Professional		$39.97	$48.84	$142.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.10 / $14.12 / $46.34	Professional	26	$12.10	$14.12	$46.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.87 / $34.72 / $96.50	Professional	TC	$27.87	$34.72	$96.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $71.73 / $121.09 / $172.63	Professional		$71.73	$121.09	$172.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.12 / $43.29 / $49.59	Professional	26	$20.12	$43.29	$49.59
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 $83.30 / $138.78 / $299.70	Professional		$83.30	$138.78	$299.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.35 / $39.65 / $115.96	Professional	26	$32.35	$39.65	$115.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.89 / $99.96 / $238.23	Professional	TC	$78.89	$99.96	$238.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $155.00 / $194.40 / $292.79	Professional		$155.00	$194.40	$292.79
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $58.00 / $89.40	Professional	26	$50.00	$58.00	$89.40
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $105.00 / $140.40 / $203.39	Professional	TC	$105.00	$140.40	$203.39
Providence Facility/Professional Professional Modifier Low / Median / High Price $62.11 / $155.00 / $280.20	Professional		$62.11	$155.00	$280.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.00 / $60.00 / $90.80	Professional	26	$40.00	$60.00	$90.80
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 $62.61 / $117.34 / $283.51	Professional		$62.61	$117.34	$283.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.57 / $41.27 / $99.70	Professional	26	$18.57	$41.27	$99.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.04 / $89.37 / $173.91	Professional	TC	$44.04	$89.37	$173.91