Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $21.05 / $28.27 / $57.67	Facility	26	$21.05	$28.27	$57.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $77.70 / $322.62 / $616.76	Facility	TC	$77.70	$322.62	$616.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.41 / $55.47 / $109.80	Professional		$28.41	$55.47	$109.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.83 / $8.85 / $37.09	Professional	26	$5.83	$8.85	$37.09
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $297.00 / $297.00 / $297.00	Professional	50	$297.00	$297.00	$297.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.90 / $54.90 / $79.31	Professional	52	$54.90	$54.90	$79.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.57 / $28.13 / $131.31	Professional	TC	$22.57	$28.13	$131.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.95 / $91.29 / $133.47	Professional		$57.95	$91.29	$133.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.31 / $21.14 / $24.24	Professional	26	$10.31	$21.14	$24.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $70.15 / $110.44	Professional	TC	$47.64	$70.15	$110.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.57 / $111.60 / $231.94	Professional		$89.57	$111.60	$231.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $16.18 / $19.41 / $56.55	Professional	26	$16.18	$19.41	$56.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $71.08 / $92.19 / $217.56	Professional	TC	$71.08	$92.19	$217.56
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $118.75 / $155.25 / $223.50	Professional		$118.75	$155.25	$223.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $29.00 / $44.70	Professional	26	$25.00	$29.00	$44.70
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $93.75 / $128.25 / $178.80	Professional	TC	$93.75	$128.25	$178.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $49.87 / $118.75 / $207.94	Professional		$49.87	$118.75	$207.94
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $20.00 / $30.00 / $45.40	Professional	26	$20.00	$30.00	$45.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.00 / $120.00 / $177.79	Professional	TC	$75.00	$120.00	$177.79
United Facility/Professional Professional Modifier Low / Median / High Price $36.09 / $87.00 / $209.50	Professional		$36.09	$87.00	$209.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.48 / $20.19 / $48.77	Professional	26	$8.48	$20.19	$48.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.19 / $66.81 / $156.19	Professional	TC	$29.19	$66.81	$156.19