Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.38 / $46.38 / $46.38	Facility	26	$46.38	$46.38	$46.38
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $92.52 / $405.31 / $900.16	Facility	TC	$92.52	$405.31	$900.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.95 / $45.05 / $139.19	Professional		$37.95	$45.05	$139.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.44 / $16.69 / $58.92	Professional	26	$14.44	$16.69	$58.92
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $28.35 / $88.11	Professional	TC	$23.51	$28.35	$88.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $110.23 / $164.06	Professional		$68.73	$110.23	$164.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.08 / $49.42 / $56.67	Professional	26	$22.08	$49.42	$56.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.64 / $60.81 / $112.85	Professional	TC	$46.64	$60.81	$112.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $110.78 / $132.93 / $288.37	Professional		$110.78	$132.93	$288.37
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $35.58 / $43.72 / $125.52	Professional	26	$35.58	$43.72	$125.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.19 / $90.24 / $215.22	Professional	TC	$71.19	$90.24	$215.22
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.25 / $184.95 / $281.61	Professional		$151.25	$184.95	$281.61
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $59.80 / $102.81	Professional	26	$55.00	$59.80	$102.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.75 / $126.90 / $178.80	Professional	TC	$93.75	$126.90	$178.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.92 / $151.25 / $269.63	Professional		$58.92	$151.25	$269.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $69.00 / $102.81	Professional	26	$46.00	$69.00	$102.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $74.26 / $120.00 / $178.80	Professional	TC	$74.26	$120.00	$178.80
United Facility/Professional Professional Modifier Low / Median / High Price $63.94 / $119.42 / $275.42	Professional		$63.94	$119.42	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.41 / $47.18 / $113.98	Professional	26	$24.41	$47.18	$113.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.20 / $80.27 / $161.44	Professional	TC	$38.20	$80.27	$161.44