Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.99 / $25.99 / $25.99	Facility	26	$25.99	$25.99	$25.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.03 / $34.36 / $95.31	Professional		$28.03	$34.36	$95.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $8.94 / $28.64	Professional	26	$7.63	$8.94	$28.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.39 / $25.42 / $66.68	Professional	TC	$20.39	$25.42	$66.68
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $85.03 / $115.21	Professional		$48.98	$85.03	$115.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $26.76 / $30.66	Professional	26	$12.76	$26.76	$30.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.22 / $58.27 / $86.31	Professional	TC	$36.22	$58.27	$86.31
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $78.45 / $94.14 / $199.93	Professional		$78.45	$94.14	$199.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $24.50 / $71.63	Professional	26	$20.23	$24.50	$71.63
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $55.04 / $69.87 / $164.58	Professional	TC	$55.04	$69.87	$164.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.25 / $130.94 / $194.45	Professional		$111.25	$130.94	$194.45
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.25 / $36.25 / $55.88	Professional	26	$31.25	$36.25	$55.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.00 / $97.20 / $138.57	Professional	TC	$80.00	$97.20	$138.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.28 / $111.25 / $194.45	Professional		$42.28	$111.25	$194.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $37.50 / $56.75	Professional	26	$25.00	$37.50	$56.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.13 / $93.00 / $138.57	Professional	TC	$62.13	$93.00	$138.57
United Facility/Professional Professional Modifier Low / Median / High Price $48.86 / $107.49 / $137.00	Professional		$48.86	$107.49	$137.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.94 / $36.75 / $47.00	Professional	26	$11.94	$36.75	$47.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.38 / $51.70 / $90.00	Professional	TC	$22.38	$51.70	$90.00