Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.86 / $44.86 / $44.86	Facility	26	$44.86	$44.86	$44.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.68 / $74.42 / $240.82	Professional		$60.68	$74.42	$240.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.71 / $18.38 / $57.89	Professional	26	$15.71	$18.38	$57.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.99 / $56.03 / $144.47	Professional	TC	$44.99	$56.03	$144.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.54 / $170.75 / $220.79	Professional		$93.54	$170.75	$220.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.08 / $48.84 / $56.44	Professional	26	$22.08	$48.84	$56.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $71.45 / $114.31 / $171.95	Professional	TC	$71.45	$114.31	$171.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $150.40 / $180.48 / $455.61	Professional		$150.40	$180.48	$455.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.78 / $42.28 / $123.63	Professional	26	$34.78	$42.28	$123.63
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $138.78 / $332.61	Professional	TC	$109.65	$138.78	$332.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $211.25 / $253.80 / $373.25	Professional		$211.25	$253.80	$373.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $53.75 / $65.00 / $104.00	Professional	26	$53.75	$65.00	$104.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $146.25 / $195.75 / $277.14	Professional	TC	$146.25	$195.75	$277.14
Providence Facility/Professional Professional Modifier Low / Median / High Price $81.25 / $211.25 / $371.30	Professional		$81.25	$211.25	$371.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.60 / $65.00 / $104.00	Professional	26	$51.60	$65.00	$104.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $124.67 / $186.00 / $276.35	Professional	TC	$124.67	$186.00	$276.35
United Facility/Professional Professional Modifier Low / Median / High Price $91.58 / $204.18 / $357.92	Professional		$91.58	$204.18	$357.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.82 / $63.96 / $107.19	Professional	26	$24.82	$63.96	$107.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.84 / $103.76 / $233.64	Professional	TC	$66.84	$103.76	$233.64