Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.21 / $102.21 / $102.21	Facility	26	$102.21	$102.21	$102.21
Aetna Facility/Professional Professional Modifier Low / Median / High Price $65.95 / $77.22 / $167.58	Professional		$65.95	$77.22	$167.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.24 / $49.50 / $92.04	Professional	26	$33.24	$49.50	$92.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.57 / $39.22 / $75.54	Professional	TC	$23.57	$39.22	$75.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.24 / $96.09 / $438.42	Professional		$48.24	$96.09	$438.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.09 / $54.54 / $273.04	Professional	26	$33.09	$54.54	$273.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $15.15 / $36.86 / $165.39	Professional	TC	$15.15	$36.86	$165.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $80.75 / $179.87 / $222.85	Professional		$80.75	$179.87	$222.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.84 / $100.51 / $114.54	Professional	26	$66.84	$100.51	$114.54
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 $100.10 / $193.98 / $345.03	Professional		$100.10	$193.98	$345.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $58.85 / $127.07 / $198.58	Professional	26	$58.85	$127.07	$198.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $31.20 / $57.60 / $147.15	Professional	TC	$31.20	$57.60	$147.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.75 / $146.30 / $331.50	Professional		$80.75	$146.30	$331.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.85 / $127.20 / $212.00	Professional	26	$58.85	$127.20	$212.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.65 / $66.00 / $162.16	Professional	TC	$30.65	$66.00	$162.16
United Facility/Professional Professional Modifier Low / Median / High Price $97.63 / $170.26 / $289.44	Professional		$97.63	$170.26	$289.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.19 / $106.04 / $180.27	Professional	26	$46.19	$106.04	$180.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.42 / $64.22 / $109.17	Professional	TC	$33.42	$64.22	$109.17