Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.24 / $29.24 / $29.24	Facility	26	$29.24	$29.24	$29.24
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.77 / $39.35 / $61.20	Professional		$38.77	$39.35	$61.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.02 / $15.58 / $23.91	Professional	26	$15.02	$15.58	$23.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.74 / $23.76 / $37.29	Professional	TC	$23.74	$23.76	$37.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $29.33 / $61.83 / $114.40	Professional		$29.33	$61.83	$114.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.75 / $33.19 / $49.24	Professional	26	$12.75	$33.19	$49.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.59 / $37.49 / $71.84	Professional	TC	$16.59	$37.49	$71.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $73.59 / $88.32 / $193.16	Professional		$73.59	$88.32	$193.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $30.44 / $88.99	Professional	26	$25.08	$30.44	$88.99
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.09 / $53.09 / $117.87	Professional	TC	$30.09	$53.09	$117.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.75 / $124.20 / $202.02	Professional		$113.75	$124.20	$202.02
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.75 / $41.85 / $74.77	Professional	26	$38.75	$41.85	$74.77
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.00 / $82.35 / $125.06	Professional	TC	$75.00	$82.35	$125.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $39.44 / $94.99 / $197.18	Professional		$39.44	$94.99	$197.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.45 / $50.00 / $76.95	Professional	26	$36.45	$50.00	$76.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $51.22 / $90.00 / $136.19	Professional	TC	$51.22	$90.00	$136.19
United Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $95.22 / $197.58	Professional		$56.63	$95.22	$197.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.76 / $39.40 / $85.06	Professional	26	$21.76	$39.40	$85.06
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.83 / $54.22 / $112.52	Professional	TC	$31.83	$54.22	$112.52