Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.23 / $104.23 / $104.23	Facility	26	$104.23	$104.23	$104.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $66.62 / $84.83 / $182.50	Professional		$66.62	$84.83	$182.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.90 / $43.03 / $93.85	Professional	26	$33.90	$43.03	$93.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.57 / $45.80 / $88.65	Professional	TC	$23.57	$45.80	$88.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $51.71 / $105.03 / $473.09	Professional		$51.71	$105.03	$473.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.03 / $48.27 / $280.69	Professional	26	$34.03	$48.27	$280.69
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $17.68 / $36.86 / $192.40	Professional	TC	$17.68	$36.86	$192.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $86.93 / $195.82 / $243.88	Professional		$86.93	$195.82	$243.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.47 / $102.94 / $117.31	Professional	26	$68.47	$102.94	$117.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.78 / $100.28 / $130.36	Professional	TC	$61.78	$100.28	$130.36
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.25 / $228.75 / $407.62	Professional		$107.25	$228.75	$407.62
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.04 / $130.80 / $197.64	Professional	26	$58.04	$130.80	$197.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $38.08 / $90.12 / $198.00	Professional	TC	$38.08	$90.12	$198.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $86.93 / $161.54 / $377.03	Professional		$86.93	$161.54	$377.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $130.80 / $212.55	Professional	26	$55.00	$130.80	$212.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.21 / $76.70 / $189.42	Professional	TC	$31.21	$76.70	$189.42
United Facility/Professional Professional Modifier Low / Median / High Price $97.10 / $183.72 / $312.32	Professional		$97.10	$183.72	$312.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.97 / $109.00 / $185.30	Professional	26	$39.97	$109.00	$185.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.39 / $74.72 / $127.02	Professional	TC	$29.39	$74.72	$127.02