Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $35.48 / $46.77 / $77.62	Facility	26	$35.48	$46.77	$77.62
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $123.03 / $512.86 / $870.96	Facility	TC	$123.03	$512.86	$870.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $53.70 / $194.98	Professional		$30.20	$53.70	$194.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $18.62 / $66.07	Professional	26	$7.94	$18.62	$66.07
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	50	$66.07	$66.07	$66.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $42.66 / $123.03	Professional	TC	$25.12	$42.66	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $120.23 / $173.78	Professional		$100.00	$120.23	$173.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $36.31 / $39.81	Professional	26	$20.89	$36.31	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $91.20 / $134.90	Professional	TC	$83.18	$91.20	$134.90
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $46.77 / $77.62	Facility	26	$34.67	$46.77	$77.62
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $100.00 / $562.34 / $691.83	Facility	TC	$100.00	$562.34	$691.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $125.89 / $204.17	Professional		$40.74	$125.89	$204.17
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $33.11 / $69.18	Professional	26	$12.88	$33.11	$69.18
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $61.66 / $251.19 / $263.03	Professional	50	$61.66	$251.19	$263.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $100.00 / $165.96	Professional	TC	$45.71	$100.00	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $190.55 / $269.15	Professional		$144.54	$190.55	$269.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $44.67 / $72.44	Professional	26	$39.81	$44.67	$72.44
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $147.91 / $204.17	Professional	TC	$104.71	$147.91	$204.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $89.13 / $123.03	Professional		$42.66	$89.13	$123.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $20.89 / $39.81	Professional	26	$9.33	$20.89	$39.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $40.74 / $97.72	Professional	TC	$28.18	$40.74	$97.72
United Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $112.20 / $223.87	Professional		$95.50	$112.20	$223.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $33.11 / $79.43	Professional	26	$28.18	$33.11	$79.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $79.43 / $158.49	Professional	TC	$64.57	$79.43	$158.49