Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.85 / $52.10 / $56.00	Facility	26	$50.85	$52.10	$56.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.59 / $45.87 / $141.32	Professional		$37.59	$45.87	$141.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.08 / $16.57 / $67.09	Professional	26	$14.08	$16.57	$67.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $29.29 / $85.31	Professional	TC	$23.51	$29.29	$85.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.19 / $112.66 / $165.85	Professional		$70.19	$112.66	$165.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.03 / $51.00 / $59.98	Professional	26	$25.03	$51.00	$59.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.15 / $61.66 / $109.23	Professional	TC	$45.15	$61.66	$109.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $112.40 / $134.88 / $296.77	Professional		$112.40	$134.88	$296.77
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.63 / $51.04 / $140.08	Professional	26	$39.63	$51.04	$140.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $67.31 / $87.33 / $178.20	Professional	TC	$67.31	$87.33	$178.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $136.25 / $190.35 / $288.32	Professional		$136.25	$190.35	$288.32
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.50 / $66.15 / $109.52	Professional	26	$57.50	$66.15	$109.52
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.75 / $124.20 / $177.45	Professional	TC	$78.75	$124.20	$177.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $60.44 / $138.18 / $256.19	Professional		$60.44	$138.18	$256.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.00 / $73.50 / $109.52	Professional	26	$48.00	$73.50	$109.52
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.89 / $120.00 / $175.86	Professional	TC	$71.89	$120.00	$175.86
United Facility/Professional Professional Modifier Low / Median / High Price $77.48 / $116.73 / $282.05	Professional		$77.48	$116.73	$282.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.69 / $67.44 / $120.61	Professional	26	$20.69	$67.44	$120.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.14 / $70.70 / $161.44	Professional	TC	$47.14	$70.70	$161.44