Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $116.49 / $116.49 / $116.49	Facility	26	$116.49	$116.49	$116.49
Aetna Facility/Professional Professional Modifier Low / Median / High Price $71.34 / $85.54 / $186.64	Professional		$71.34	$85.54	$186.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.96 / $47.02 / $104.89	Professional	26	$37.96	$47.02	$104.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.33 / $42.34 / $81.75	Professional	TC	$24.33	$42.34	$81.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.21 / $105.92 / $489.16	Professional		$54.21	$105.92	$489.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $53.64 / $311.31	Professional	26	$37.79	$53.64	$311.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $16.41 / $38.11 / $177.85	Professional	TC	$16.41	$38.11	$177.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $90.25 / $200.08 / $247.03	Professional		$90.25	$200.08	$247.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.30 / $114.72 / $133.08	Professional	26	$76.30	$114.72	$133.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.79 / $92.20 / $119.86	Professional	TC	$56.79	$92.20	$119.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.31 / $237.50 / $412.96	Professional		$108.31	$237.50	$412.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $63.90 / $144.00 / $221.43	Professional	26	$63.90	$144.00	$221.43
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $35.36 / $85.80 / $183.00	Professional	TC	$35.36	$85.80	$183.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.50 / $164.35 / $367.50	Professional		$89.50	$164.35	$367.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.00 / $134.19 / $235.95	Professional	26	$61.00	$134.19	$235.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.90 / $70.84 / $175.07	Professional	TC	$31.90	$70.84	$175.07
United Facility/Professional Professional Modifier Low / Median / High Price $105.06 / $189.96 / $286.57	Professional		$105.06	$189.96	$286.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.63 / $119.86 / $182.39	Professional	26	$43.63	$119.86	$182.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.54 / $69.06 / $138.12	Professional	TC	$35.54	$69.06	$138.12