Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.86 / $22.86 / $22.86	Facility	26	$22.86	$22.86	$22.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $36.00 / $138.78 / $275.08	Facility	TC	$36.00	$138.78	$275.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $21.21 / $25.94 / $64.81	Professional		$21.21	$25.94	$64.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.42 / $7.50 / $25.51	Professional	26	$6.42	$7.50	$25.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.78 / $18.44 / $39.65	Professional	TC	$14.78	$18.44	$39.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $64.87 / $75.48	Professional		$33.11	$64.87	$75.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.29 / $23.53 / $26.95	Professional	26	$11.29	$23.53	$26.95
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $21.83 / $37.92 / $50.13	Professional	TC	$21.83	$37.92	$50.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $45.21 / $63.09 / $136.07	Professional		$45.21	$63.09	$136.07
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $21.53 / $62.99	Professional	26	$17.80	$21.53	$62.99
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $32.74 / $41.73 / $97.89	Professional	TC	$32.74	$41.73	$97.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.25 / $87.75 / $146.25	Professional		$81.25	$87.75	$146.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.50 / $29.90 / $49.17	Professional	26	$27.50	$29.90	$49.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $53.75 / $58.05 / $84.93	Professional	TC	$53.75	$58.05	$84.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $78.00 / $134.10	Professional		$30.19	$78.00	$134.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.00 / $33.00 / $49.94	Professional	26	$22.00	$33.00	$49.94
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $42.13 / $57.00 / $95.34	Professional	TC	$42.13	$57.00	$95.34
United Facility/Professional Professional Modifier Low / Median / High Price $33.96 / $51.90 / $111.59	Professional		$33.96	$51.90	$111.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.09 / $22.44 / $54.20	Professional	26	$10.09	$22.44	$54.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $45.51 / $76.27	Professional	TC	$27.55	$45.51	$76.27