Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.24 / $45.24 / $45.24	Facility	26	$45.24	$45.24	$45.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.24 / $60.01 / $153.77	Professional		$51.24	$60.01	$153.77
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.50 / $15.46 / $49.82	Professional	26	$13.50	$15.46	$49.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $37.71 / $44.55 / $103.95	Professional	TC	$37.71	$44.55	$103.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $81.63 / $143.85 / $179.78	Professional		$81.63	$143.85	$179.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.10 / $46.53 / $52.29	Professional	26	$21.10	$46.53	$52.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.53 / $97.33 / $129.74	Professional	TC	$60.53	$97.33	$129.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.00 / $157.19 / $331.49	Professional		$131.00	$157.19	$331.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $41.83 / $122.33	Professional	26	$33.97	$41.83	$122.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $91.61 / $116.46 / $269.43	Professional	TC	$91.61	$116.46	$269.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $192.50 / $218.70 / $335.25	Professional		$192.50	$218.70	$335.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.50 / $57.20 / $93.87	Professional	26	$52.50	$57.20	$93.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $138.75 / $162.00 / $241.38	Professional	TC	$138.75	$162.00	$241.38
Providence Facility/Professional Professional Modifier Low / Median / High Price $73.15 / $186.00 / $335.25	Professional		$73.15	$186.00	$335.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.34 / $63.00 / $97.61	Professional	26	$43.34	$63.00	$97.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.28 / $162.00 / $245.16	Professional	TC	$113.28	$162.00	$245.16
United Facility/Professional Professional Modifier Low / Median / High Price $86.77 / $128.66 / $290.62	Professional		$86.77	$128.66	$290.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.82 / $43.54 / $94.51	Professional	26	$22.82	$43.54	$94.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.02 / $94.62 / $196.11	Professional	TC	$61.02	$94.62	$196.11