Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.01 / $38.54 / $38.54	Facility	26	$28.01	$38.54	$38.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.52 / $42.40 / $85.40	Professional		$34.52	$42.40	$85.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.44 / $11.16 / $30.84	Professional	26	$9.44	$11.16	$30.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $42.70 / $42.70 / $59.81	Professional	52	$42.70	$42.70	$59.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.05 / $31.24 / $54.56	Professional	TC	$25.05	$31.24	$54.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $44.01 / $94.15 / $110.04	Professional		$44.01	$94.15	$110.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.74 / $31.26 / $33.09	Professional	26	$13.74	$31.26	$33.09
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.26 / $61.12 / $76.95	Professional	TC	$30.26	$61.12	$76.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $69.95 / $84.42 / $181.17	Professional		$69.95	$84.42	$181.17
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.83 / $26.37 / $77.16	Professional	26	$21.83	$26.37	$77.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.76 / $58.23 / $137.02	Professional	TC	$44.76	$58.23	$137.02
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.75 / $131.25 / $209.84	Professional		$108.75	$131.25	$209.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $39.00 / $60.35	Professional	26	$33.75	$39.00	$60.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.00 / $93.75 / $142.00	Professional	TC	$75.00	$93.75	$142.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $40.19 / $108.75 / $196.68	Professional		$40.19	$108.75	$196.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $40.50 / $61.29	Professional	26	$32.00	$40.50	$61.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.80 / $93.75 / $142.00	Professional	TC	$70.80	$93.75	$142.00
United Facility/Professional Professional Modifier Low / Median / High Price $31.76 / $86.16 / $189.34	Professional		$31.76	$86.16	$189.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.93 / $27.50 / $66.42	Professional	26	$13.93	$27.50	$66.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.77 / $48.90 / $122.92	Professional	TC	$39.77	$48.90	$122.92