Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.93 / $56.33 / $97.14	Facility	26	$40.93	$56.33	$97.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.71 / $68.67 / $196.76	Professional		$47.71	$68.67	$196.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.61 / $20.35 / $69.75	Professional	26	$13.61	$20.35	$69.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.09 / $42.47 / $140.41	Professional	TC	$34.09	$42.47	$140.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.17 / $133.36 / $189.56	Professional		$81.17	$133.36	$189.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.63 / $45.35 / $48.77	Professional	26	$19.63	$45.35	$48.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.53 / $84.59 / $144.21	Professional	TC	$61.53	$84.59	$144.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $128.97 / $157.19 / $332.04	Professional		$128.97	$157.19	$332.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.55 / $38.57 / $110.44	Professional	26	$31.55	$38.57	$110.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $92.13 / $119.37 / $238.59	Professional	TC	$92.13	$119.37	$238.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $177.50 / $218.70 / $317.37	Professional		$177.50	$218.70	$317.37
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.75 / $58.50 / $90.00	Professional	26	$48.75	$58.50	$90.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $121.25 / $166.05 / $230.21	Professional	TC	$121.25	$166.05	$230.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $69.64 / $177.50 / $304.64	Professional		$69.64	$177.50	$304.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.00 / $58.50 / $90.00	Professional	26	$46.00	$58.50	$90.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $94.80 / $154.50 / $230.21	Professional	TC	$94.80	$154.50	$230.21
United Facility/Professional Professional Modifier Low / Median / High Price $72.69 / $137.47 / $304.14	Professional		$72.69	$137.47	$304.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.07 / $44.14 / $96.98	Professional	26	$14.07	$44.14	$96.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.12 / $103.50 / $182.76	Professional	TC	$53.12	$103.50	$182.76