Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.25 / $55.38 / $55.38	Facility	26	$40.25	$55.38	$55.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $34.85 / $42.61 / $150.01	Professional		$34.85	$42.61	$150.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.59 / $14.87 / $44.31	Professional	26	$12.59	$14.87	$44.31
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $66.68 / $66.68 / $95.10	Professional	52	$66.68	$66.68	$95.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.26 / $27.74 / $89.04	Professional	TC	$22.26	$27.74	$89.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $68.75 / $106.19 / $160.12	Professional		$68.75	$106.19	$160.12
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.12 / $44.52 / $47.48	Professional	26	$20.12	$44.52	$47.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.63 / $61.66 / $115.26	Professional	TC	$48.63	$61.66	$115.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $94.14 / $131.97 / $281.77	Professional		$94.14	$131.97	$281.77
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.55 / $37.90 / $110.83	Professional	26	$31.55	$37.90	$110.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.58 / $94.14 / $222.17	Professional	TC	$72.58	$94.14	$222.17
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.50 / $183.60 / $263.25	Professional		$132.50	$183.60	$263.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.75 / $53.30 / $87.17	Professional	26	$48.75	$53.30	$87.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.25 / $130.94 / $187.20	Professional	TC	$81.25	$130.94	$187.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $58.49 / $132.50 / $242.76	Professional		$58.49	$132.50	$242.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.00 / $58.50 / $88.53	Professional	26	$43.00	$58.50	$88.53
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $75.84 / $127.50 / $185.52	Professional	TC	$75.84	$127.50	$185.52
United Facility/Professional Professional Modifier Low / Median / High Price $60.14 / $106.24 / $185.92	Professional		$60.14	$106.24	$185.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $18.57 / $56.97 / $79.00	Professional	26	$18.57	$56.97	$79.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.72 / $73.17 / $119.45	Professional	TC	$38.72	$73.17	$119.45