Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.95 / $40.95 / $40.95	Facility	26	$40.95	$40.95	$40.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.39 / $49.44 / $102.07	Professional		$28.39	$49.44	$102.07
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.49 / $15.40 / $36.86	Professional	26	$13.49	$15.40	$36.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $13.01 / $34.04 / $65.20	Professional	TC	$13.01	$34.04	$65.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $26.68 / $56.22 / $256.49	Professional		$26.68	$56.22	$256.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.43 / $19.22 / $111.88	Professional	26	$13.43	$19.22	$111.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.25 / $26.77 / $144.61	Professional	TC	$13.25	$26.77	$144.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $48.18 / $100.52 / $138.22	Professional		$48.18	$100.52	$138.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.08 / $40.72 / $46.40	Professional	26	$27.08	$40.72	$46.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $44.77 / $72.78 / $94.61	Professional	TC	$44.77	$72.78	$94.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.00 / $123.75 / $216.46	Professional		$57.00	$123.75	$216.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $22.90 / $51.60 / $78.69	Professional	26	$22.90	$51.60	$78.69
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $28.56 / $57.20 / $146.47	Professional	TC	$28.56	$57.20	$146.47
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.35 / $76.50 / $202.30	Professional		$42.35	$76.50	$202.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.00 / $51.60 / $83.85	Professional	26	$22.00	$51.60	$83.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.73 / $53.46 / $140.63	Professional	TC	$18.73	$53.46	$140.63
United Facility/Professional Professional Modifier Low / Median / High Price $35.54 / $99.60 / $169.32	Professional		$35.54	$99.60	$169.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.29 / $43.44 / $73.84	Professional	26	$22.29	$43.44	$73.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.14 / $56.16 / $95.47	Professional	TC	$22.14	$56.16	$95.47