Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.87 / $87.87 / $87.87	Facility	26	$87.87	$87.87	$87.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $56.32 / $71.42 / $155.35	Professional		$56.32	$71.42	$155.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.87 / $36.13 / $79.12	Professional	26	$28.87	$36.13	$79.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.19 / $39.22 / $76.23	Professional	TC	$20.19	$39.22	$76.23
Cigna Facility/Professional Professional Modifier Low / Median / High Price $43.89 / $89.84 / $401.01	Professional		$43.89	$89.84	$401.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.74 / $40.67 / $235.62	Professional	26	$28.74	$40.67	$235.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.15 / $33.09 / $165.39	Professional	TC	$15.15	$33.09	$165.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.09 / $167.53 / $209.20	Professional		$74.09	$167.53	$209.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.14 / $87.42 / $99.62	Professional	26	$58.14	$87.42	$99.62
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.28 / $86.53 / $112.48	Professional	TC	$53.28	$86.53	$112.48
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.00 / $189.20 / $343.54	Professional		$91.00	$189.20	$343.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.99 / $110.40 / $163.76	Professional	26	$48.99	$110.40	$163.76
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.64 / $65.65 / $169.50	Professional	TC	$32.64	$65.65	$169.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.00 / $133.00 / $307.50	Professional		$70.00	$133.00	$307.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.50 / $109.20 / $184.00	Professional	26	$45.50	$109.20	$184.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $27.24 / $65.65 / $162.16	Professional	TC	$27.24	$65.65	$162.16
United Facility/Professional Professional Modifier Low / Median / High Price $82.24 / $155.74 / $264.76	Professional		$82.24	$155.74	$264.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.07 / $91.50 / $155.55	Professional	26	$53.07	$91.50	$155.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.17 / $64.23 / $109.21	Professional	TC	$29.17	$64.23	$109.21