Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $33.03 / $45.34	Facility	26	$23.99	$33.03	$45.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $47.57 / $105.90	Professional		$25.25	$47.57	$105.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $8.22 / $31.44	Professional	26	$7.03	$8.22	$31.44
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $42.36 / $42.36 / $60.58	Professional	52	$42.36	$42.36	$60.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $22.70 / $76.94	Professional	TC	$18.21	$22.70	$76.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.03 / $78.73 / $101.98	Professional		$43.03	$78.73	$101.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $24.72 / $28.30	Professional	26	$11.77	$24.72	$28.30
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.26 / $54.02 / $75.45	Professional	TC	$31.26	$54.02	$75.45
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $68.73 / $82.47 / $177.76	Professional		$68.73	$82.47	$177.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.60 / $22.61 / $66.17	Professional	26	$18.60	$22.61	$66.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.34 / $60.15 / $143.91	Professional	TC	$47.34	$60.15	$143.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.00 / $116.10 / $176.57	Professional		$95.00	$116.10	$176.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.75 / $33.35 / $51.41	Professional	26	$28.75	$33.35	$51.41
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.25 / $85.05 / $125.16	Professional	TC	$66.25	$85.05	$125.16
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.97 / $95.00 / $176.57	Professional		$36.97	$95.00	$176.57
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $34.50 / $52.21	Professional	26	$23.00	$34.50	$52.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.08 / $84.00 / $125.16	Professional	TC	$56.08	$84.00	$125.16
United Facility/Professional Professional Modifier Low / Median / High Price $38.45 / $98.61 / $180.79	Professional		$38.45	$98.61	$180.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.62 / $23.56 / $62.21	Professional	26	$10.62	$23.56	$62.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.52 / $54.13 / $118.58	Professional	TC	$26.52	$54.13	$118.58