Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.85 / $46.85 / $46.85	Facility	26	$46.85	$46.85	$46.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.14 / $20.85 / $126.66	Professional		$17.14	$20.85	$126.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.80 / $59.71	Professional	26	$7.03	$9.80	$59.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $10.11 / $12.62 / $75.06	Professional	TC	$10.11	$12.62	$75.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.42 / $65.23 / $143.02	Professional		$52.42	$65.23	$143.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.91 / $24.72 / $55.25	Professional	26	$14.91	$24.72	$55.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $27.70 / $42.18 / $91.14	Professional	TC	$27.70	$42.18	$91.14
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $104.33 / $125.19 / $269.94	Professional		$104.33	$125.19	$269.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.40 / $44.15 / $129.09	Professional	26	$36.40	$44.15	$129.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.28 / $81.51 / $189.93	Professional	TC	$64.28	$81.51	$189.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.10 / $172.80 / $236.07	Professional		$61.10	$172.80	$236.07
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $29.90 / $60.75 / $87.75	Professional	26	$29.90	$60.75	$87.75
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.20 / $112.05 / $153.72	Professional	TC	$31.20	$112.05	$153.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $41.09 / $108.72 / $230.01	Professional		$41.09	$108.72	$230.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.72 / $56.25 / $86.96	Professional	26	$24.72	$56.25	$86.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.00 / $103.75 / $146.87	Professional	TC	$30.00	$103.75	$146.87
United Facility/Professional Professional Modifier Low / Median / High Price $42.42 / $109.45 / $187.00	Professional		$42.42	$109.45	$187.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.23 / $46.00 / $100.00	Professional	26	$16.23	$46.00	$100.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.43 / $69.59 / $106.75	Professional	TC	$27.43	$69.59	$106.75