Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.59 / $57.59 / $57.59	Facility	26	$57.59	$57.59	$57.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $42.82 / $60.31 / $126.70	Professional		$42.82	$60.31	$126.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.85 / $23.78 / $51.85	Professional	26	$18.85	$23.78	$51.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.05 / $38.88 / $74.86	Professional	TC	$19.05	$38.88	$74.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.18 / $75.08 / $317.66	Professional		$34.18	$75.08	$317.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.04 / $26.82 / $154.36	Professional	26	$19.04	$26.82	$154.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.15 / $30.44 / $163.31	Professional	TC	$15.15	$30.44	$163.31
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $60.14 / $136.65 / $174.53	Professional		$60.14	$136.65	$174.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.11 / $57.30 / $65.29	Professional	26	$38.11	$57.30	$65.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.78 / $85.73 / $111.44	Professional	TC	$52.78	$85.73	$111.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.84 / $156.25 / $278.75	Professional		$70.84	$156.25	$278.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.42 / $72.00 / $106.80	Professional	26	$31.42	$72.00	$106.80
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $32.64 / $73.31 / $168.00	Professional	TC	$32.64	$73.31	$168.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.11 / $102.44 / $253.50	Professional		$54.11	$102.44	$253.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.50 / $72.00 / $118.95	Professional	26	$30.50	$72.00	$118.95
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $24.97 / $65.00 / $160.72	Professional	TC	$24.97	$65.00	$160.72
United Facility/Professional Professional Modifier Low / Median / High Price $63.67 / $123.36 / $209.71	Professional		$63.67	$123.36	$209.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.79 / $59.94 / $90.43	Professional	26	$50.79	$59.94	$90.43
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.98 / $63.42 / $107.81	Professional	TC	$24.98	$63.42	$107.81