Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $53.54 / $53.54 / $53.54	Facility		$53.54	$53.54	$53.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.93 / $7.93 / $7.93	Facility	26	$7.93	$7.93	$7.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.44 / $31.91 / $70.36	Professional		$30.44	$31.91	$70.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $4.23 / $4.30 / $8.35	Professional	26	$4.23	$4.30	$8.35
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $28.15 / $28.15 / $47.98	Professional	52	$28.15	$28.15	$47.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.21 / $27.61 / $47.95	Professional	TC	$26.21	$27.61	$47.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $18.55 / $40.40 / $80.73	Professional		$18.55	$40.40	$80.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $2.94 / $6.70 / $10.39	Professional	26	$2.94	$6.70	$10.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.62 / $33.71 / $70.63	Professional	TC	$15.62	$33.71	$70.63
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $24.49 / $24.49 / $80.48	Facility		$24.49	$24.49	$80.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.88 / $66.95 / $138.27	Professional		$53.88	$66.95	$138.27
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $8.73 / $24.12	Professional	26	$7.28	$8.73	$24.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.80 / $58.23 / $139.30	Professional	TC	$45.80	$58.23	$139.30
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.34 / $94.50 / $126.27	Professional		$74.34	$94.50	$126.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $10.80 / $12.15 / $17.55	Professional	26	$10.80	$12.15	$17.55
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.00 / $82.35 / $102.72	Professional	TC	$63.00	$82.35	$102.72
Providence Facility/Professional Facility Modifier Low / Median / High Price $24.49 / $29.39 / $80.48	Facility		$24.49	$29.39	$80.48
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.98 / $69.59 / $118.66	Professional		$28.98	$69.59	$118.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.11 / $13.50 / $20.43	Professional	26	$7.11	$13.50	$20.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.27 / $79.50 / $102.72	Professional	TC	$48.27	$79.50	$102.72
United Facility/Professional Professional Modifier Low / Median / High Price $48.24 / $50.76 / $76.14	Professional		$48.24	$50.76	$76.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.73 / $8.32 / $12.48	Professional	26	$7.73	$8.32	$12.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.92 / $42.44 / $53.73	Professional	TC	$39.92	$42.44	$53.73