Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.61 / $47.66 / $96.06	Facility	26	$34.61	$47.66	$96.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $72.26 / $252.95 / $573.84	Facility	TC	$72.26	$252.95	$573.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.19 / $35.90 / $123.31	Professional		$30.19	$35.90	$123.31
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.31 / $14.56 / $45.39	Professional	26	$10.31	$14.56	$45.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.89 / $24.00 / $78.05	Professional	TC	$19.89	$24.00	$78.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.88 / $87.10 / $130.63	Professional		$55.88	$87.10	$130.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.68 / $35.61 / $40.79	Professional	26	$16.68	$35.61	$40.79
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $51.47 / $92.35	Professional	TC	$39.20	$51.47	$92.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.75 / $107.70 / $229.74	Professional		$89.75	$107.70	$229.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.68 / $32.63 / $93.08	Professional	26	$26.68	$32.63	$93.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.31 / $75.69 / $178.43	Professional	TC	$58.31	$75.69	$178.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.50 / $149.85 / $225.74	Professional		$122.50	$149.85	$225.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $41.25 / $47.85 / $73.76	Professional	26	$41.25	$47.85	$73.76
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.25 / $105.30 / $151.97	Professional	TC	$81.25	$105.30	$151.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.30 / $122.50 / $214.79	Professional		$47.30	$122.50	$214.79
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.00 / $49.50 / $74.91	Professional	26	$33.00	$49.50	$74.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $61.00 / $102.00 / $151.97	Professional	TC	$61.00	$102.00	$151.97
United Facility/Professional Professional Modifier Low / Median / High Price $49.87 / $95.36 / $219.16	Professional		$49.87	$95.36	$219.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.50 / $33.97 / $82.05	Professional	26	$16.50	$33.97	$82.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $67.01 / $134.13	Professional	TC	$32.36	$67.01	$134.13