Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.55 / $53.55 / $53.55	Facility	26	$53.55	$53.55	$53.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.64 / $72.25 / $231.88	Professional		$61.64	$72.25	$231.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.61 / $17.93 / $58.97	Professional	26	$15.61	$17.93	$58.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $54.32 / $172.91	Professional	TC	$46.00	$54.32	$172.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.30 / $172.42 / $280.88	Professional		$120.30	$172.42	$280.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.53 / $53.87 / $63.69	Professional	26	$25.53	$53.87	$63.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.78 / $118.55 / $221.41	Professional	TC	$94.78	$118.55	$221.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $194.02 / $232.89 / $488.02	Professional		$194.02	$232.89	$488.02
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.25 / $50.45 / $147.55	Professional	26	$41.25	$50.45	$147.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.69 / $183.39 / $429.20	Professional	TC	$144.69	$183.39	$429.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $270.00 / $324.00 / $493.94	Professional		$270.00	$324.00	$493.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.75 / $68.84 / $116.22	Professional	26	$63.75	$68.84	$116.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $205.00 / $255.15 / $377.72	Professional	TC	$205.00	$255.15	$377.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $103.27 / $270.00 / $454.14	Professional		$103.27	$270.00	$454.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $78.00 / $116.22	Professional	26	$50.00	$78.00	$116.22
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $145.36 / $253.50 / $377.72	Professional	TC	$145.36	$253.50	$377.72
United Facility/Professional Professional Modifier Low / Median / High Price $104.35 / $280.50 / $470.09	Professional		$104.35	$280.50	$470.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.53 / $63.70 / $128.11	Professional	26	$26.53	$63.70	$128.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.44 / $170.05 / $341.98	Professional	TC	$79.44	$170.05	$341.98