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 Facility Modifier TC Low / Median / High Price $79.15 / $298.16 / $559.70	Facility	TC	$79.15	$298.16	$559.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.67 / $51.98 / $133.52	Professional		$42.67	$51.98	$133.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.49 / $16.87 / $46.34	Professional	26	$14.49	$16.87	$46.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.17 / $35.11 / $87.18	Professional	TC	$28.17	$35.11	$87.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.26 / $131.63 / $159.36	Professional		$67.26	$131.63	$159.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.12 / $46.51 / $53.00	Professional	26	$20.12	$46.51	$53.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.14 / $78.64 / $112.85	Professional	TC	$47.14	$78.64	$112.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $108.21 / $130.02 / $280.23	Professional		$108.21	$130.02	$280.23
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 $71.95 / $91.23 / $215.22	Professional	TC	$71.95	$91.23	$215.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $167.50 / $194.30 / $290.25	Professional		$167.50	$194.30	$290.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $62.50 / $100.00	Professional	26	$50.00	$62.50	$100.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $105.00 / $126.90 / $185.51	Professional	TC	$105.00	$126.90	$185.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $62.16 / $160.80 / $277.14	Professional		$62.16	$160.80	$277.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.00 / $62.50 / $100.00	Professional	26	$48.00	$62.50	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $83.31 / $124.50 / $185.51	Professional	TC	$83.31	$124.50	$185.51
United Facility/Professional Professional Modifier Low / Median / High Price $70.03 / $115.13 / $224.00	Professional		$70.03	$115.13	$224.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.82 / $49.00 / $98.00	Professional	26	$22.82	$49.00	$98.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.11 / $83.30 / $133.28	Professional	TC	$53.11	$83.30	$133.28