Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.50 / $95.50 / $95.50	Facility		$95.50	$95.50	$95.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $20.42 / $27.54 / $30.20	Professional		$20.42	$27.54	$30.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.98 / $8.32 / $74.13	Professional	26	$3.98	$8.32	$74.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $14.45 / $22.91 / $23.44	Professional	TC	$14.45	$22.91	$23.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $22.91 / $22.91	Professional		$22.91	$22.91	$22.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $5.37 / $5.37 / $5.37	Professional	26	$5.37	$5.37	$5.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $17.38 / $17.38	Professional	TC	$17.38	$17.38	$17.38
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $14.79 / $32.36 / $95.50	Facility		$14.79	$32.36	$95.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $10.96 / $33.11 / $85.11	Professional		$10.96	$33.11	$85.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $3.55 / $12.02 / $89.13	Professional	26	$3.55	$12.02	$89.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $7.76 / $23.99 / $42.66	Professional	TC	$7.76	$23.99	$42.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.50 / $67.61 / $91.20	Professional		$19.50	$67.61	$91.20
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $6.17 / $19.50 / $23.99	Professional	26	$6.17	$19.50	$23.99
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $13.18 / $47.86 / $67.61	Professional	TC	$13.18	$47.86	$67.61
Providence Facility/Professional Facility Modifier Low / Median / High Price $11.22 / $14.79 / $33.11	Facility		$11.22	$14.79	$33.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $22.91 / $22.91	Professional		$22.91	$22.91	$22.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $5.37 / $5.37 / $5.37	Professional	26	$5.37	$5.37	$5.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $17.38 / $17.38 / $17.38	Professional	TC	$17.38	$17.38	$17.38
United Facility/Professional Professional Modifier Low / Median / High Price $15.85 / $37.15 / $54.95	Professional		$15.85	$37.15	$54.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $4.68 / $12.30 / $18.62	Professional	26	$4.68	$12.30	$18.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $11.22 / $24.55 / $37.15	Professional	TC	$11.22	$24.55	$37.15