Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.12 / $66.00 / $122.90	Professional		$52.12	$66.00	$122.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.34 / $27.68 / $60.46	Professional	26	$22.34	$27.68	$60.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.79 / $38.32 / $62.44	Professional	TC	$29.79	$38.32	$62.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $37.54 / $48.24 / $155.96	Professional		$37.54	$48.24	$155.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.97 / $20.75 / $78.61	Professional	26	$16.97	$20.75	$78.61
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.58 / $27.48 / $77.34	Professional	TC	$20.58	$27.48	$77.34
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.31 / $135.87 / $162.18	Professional		$77.31	$135.87	$162.18
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $58.50 / $61.16	Professional	26	$38.02	$58.50	$61.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.28 / $74.09 / $76.65	Professional	TC	$39.28	$74.09	$76.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.00 / $95.90 / $190.35	Professional		$67.00	$95.90	$190.35
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.88 / $43.40 / $82.35	Professional	26	$27.88	$43.40	$82.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $36.56 / $52.50 / $108.00	Professional	TC	$36.56	$52.50	$108.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.24 / $80.19 / $201.00	Professional		$48.24	$80.19	$201.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.40 / $43.40 / $91.50	Professional	26	$26.40	$43.40	$91.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.79 / $51.75 / $109.50	Professional	TC	$32.79	$51.75	$109.50
United Facility/Professional Professional Modifier Low / Median / High Price $58.68 / $118.50 / $137.01	Professional		$58.68	$118.50	$137.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $20.47 / $52.41 / $62.00	Professional	26	$20.47	$52.41	$62.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.86 / $58.58 / $75.01	Professional	TC	$23.86	$58.58	$75.01