Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $47.86 / $58.88	Facility	26	$44.67	$47.86	$58.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $54.95 / $173.78	Professional		$32.36	$54.95	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.00 / $18.20 / $46.77	Professional	26	$10.00	$18.20	$46.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $36.31 / $83.18	Professional	TC	$20.89	$36.31	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $112.20 / $158.49	Professional		$89.13	$112.20	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $41.69 / $52.48	Professional	26	$25.70	$41.69	$52.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $79.43 / $112.20	Professional	TC	$70.79	$79.43	$112.20
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $50.12 / $58.88	Facility	26	$47.86	$50.12	$58.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $114.82 / $177.83	Professional		$66.07	$114.82	$177.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $40.74 / $64.57	Professional	26	$21.38	$40.74	$64.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $79.43 / $112.20	Professional	TC	$47.86	$79.43	$112.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $177.83 / $257.04	Professional		$138.04	$177.83	$257.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $54.95 / $93.33	Professional	26	$51.29	$54.95	$93.33
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $123.03 / $173.78	Professional	TC	$87.10	$123.03	$173.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $89.13 / $131.83	Professional		$39.81	$89.13	$131.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.75 / $25.70 / $52.48	Professional	26	$11.75	$25.70	$52.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $35.48 / $83.18	Professional	TC	$24.55	$35.48	$83.18
United Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $109.65 / $223.87	Professional		$97.72	$109.65	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $43.65 / $89.13	Professional	26	$35.48	$43.65	$89.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $67.61 / $134.90	Professional	TC	$56.23	$67.61	$134.90