Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.15 / $47.15 / $47.15	Facility	26	$47.15	$47.15	$47.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.15 / $67.59 / $170.42	Professional		$55.15	$67.59	$170.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.58 / $15.82 / $51.94	Professional	26	$13.58	$15.82	$51.94
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.56 / $51.77 / $73.20	Professional	TC	$41.56	$51.77	$73.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.75 / $113.97 / $143.51	Professional		$62.75	$113.97	$143.51
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.05 / $48.06 / $56.01	Professional	26	$23.05	$48.06	$56.01
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.69 / $65.91 / $92.35	Professional	TC	$39.69	$65.91	$92.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $100.28 / $120.33 / $262.89	Professional		$100.28	$120.33	$262.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.40 / $44.46 / $130.00	Professional	26	$36.40	$44.46	$130.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.06 / $76.65 / $152.90	Professional	TC	$59.06	$76.65	$152.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $138.75 / $167.40 / $252.56	Professional		$138.75	$167.40	$252.56
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.25 / $60.75 / $100.58	Professional	26	$56.25	$60.75	$100.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.25 / $106.65 / $151.97	Professional	TC	$81.25	$106.65	$151.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $52.98 / $138.75 / $246.78	Professional		$52.98	$138.75	$246.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.31 / $67.50 / $100.58	Professional	26	$45.31	$67.50	$100.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $68.18 / $102.00 / $151.97	Professional	TC	$68.18	$102.00	$151.97
United Facility/Professional Professional Modifier Low / Median / High Price $94.80 / $124.20 / $249.78	Professional		$94.80	$124.20	$249.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.76 / $46.62 / $112.62	Professional	26	$21.76	$46.62	$112.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.55 / $68.20 / $136.34	Professional	TC	$54.55	$68.20	$136.34