Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.85 / $47.52 / $108.12	Facility	26	$46.85	$47.52	$108.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.75 / $66.58 / $205.87	Professional		$56.75	$66.58	$205.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.36 / $16.52 / $61.50	Professional	26	$14.36	$16.52	$61.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.39 / $50.05 / $154.27	Professional	TC	$42.39	$50.05	$154.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $105.94 / $158.31 / $250.37	Professional		$105.94	$158.31	$250.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.06 / $49.10 / $56.26	Professional	26	$23.06	$49.10	$56.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $82.88 / $109.21 / $198.49	Professional	TC	$82.88	$109.21	$198.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $166.65 / $204.75 / $431.53	Professional		$166.65	$204.75	$431.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.40 / $44.15 / $129.09	Professional	26	$36.40	$44.15	$129.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $129.09 / $161.10 / $322.30	Professional	TC	$129.09	$161.10	$322.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $228.75 / $284.85 / $424.65	Professional		$228.75	$284.85	$424.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.25 / $60.75 / $102.81	Professional	26	$56.25	$60.75	$102.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $171.25 / $224.10 / $321.83	Professional	TC	$171.25	$224.10	$321.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $91.36 / $228.75 / $405.83	Professional		$91.36	$228.75	$405.83
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 $130.35 / $216.00 / $321.83	Professional	TC	$130.35	$216.00	$321.83
United Facility/Professional Professional Modifier Low / Median / High Price $96.19 / $223.80 / $404.43	Professional		$96.19	$223.80	$404.43
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.41 / $45.01 / $113.12	Professional	26	$24.41	$45.01	$113.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $68.44 / $142.61 / $286.66	Professional	TC	$68.44	$142.61	$286.66