Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.09 / $40.09 / $40.09	Facility	26	$40.09	$40.09	$40.09
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $76.61 / $295.33 / $541.72	Facility	TC	$76.61	$295.33	$541.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.22 / $41.89 / $128.52	Professional		$35.22	$41.89	$128.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.06 / $13.93 / $44.14	Professional	26	$12.06	$13.93	$44.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.17 / $27.96 / $84.38	Professional	TC	$23.17	$27.96	$84.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $64.29 / $101.74 / $153.37	Professional		$64.29	$101.74	$153.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.13 / $41.77 / $47.22	Professional	26	$19.13	$41.77	$47.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.15 / $59.96 / $109.23	Professional	TC	$45.15	$59.96	$109.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $103.50 / $124.20 / $269.72	Professional		$103.50	$124.20	$269.72
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.73 / $37.78 / $110.44	Professional	26	$30.73	$37.78	$110.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $68.88 / $87.33 / $208.33	Professional	TC	$68.88	$87.33	$208.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $174.15 / $261.50	Professional		$141.25	$174.15	$261.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $47.50 / $51.30 / $84.93	Professional	26	$47.50	$51.30	$84.93
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $92.50 / $122.85 / $176.57	Professional	TC	$92.50	$122.85	$176.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $55.54 / $141.25 / $251.35	Professional		$55.54	$141.25	$251.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.00 / $57.00 / $86.26	Professional	26	$39.00	$57.00	$86.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.89 / $118.50 / $176.57	Professional	TC	$71.89	$118.50	$176.57
United Facility/Professional Professional Modifier Low / Median / High Price $59.60 / $110.82 / $254.40	Professional		$59.60	$110.82	$254.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $39.32 / $94.97	Professional	26	$19.39	$39.32	$94.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $40.21 / $78.16 / $156.19	Professional	TC	$40.21	$78.16	$156.19