Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.45 / $40.45 / $40.45	Facility	26	$40.45	$40.45	$40.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $38.49 / $61.17 / $100.94	Professional		$38.49	$61.17	$100.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.88 / $16.85 / $36.43	Professional	26	$12.88	$16.85	$36.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.61 / $44.32 / $64.51	Professional	TC	$25.61	$44.32	$64.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $46.30 / $75.19 / $323.69	Professional		$46.30	$75.19	$323.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.43 / $18.77 / $110.51	Professional	26	$13.43	$18.77	$110.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.97 / $56.69 / $213.18	Professional	TC	$31.97	$56.69	$213.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $67.56 / $101.59 / $129.94	Professional		$67.56	$101.59	$129.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.28 / $39.52 / $45.03	Professional	26	$26.28	$39.52	$45.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.78 / $64.36 / $87.26	Professional	TC	$39.78	$64.36	$87.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $79.88 / $160.60 / $249.15	Professional		$79.88	$160.60	$249.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $23.52 / $51.25 / $75.03	Professional	26	$23.52	$51.25	$75.03
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.91 / $113.30 / $178.20	Professional	TC	$55.91	$113.30	$178.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $59.00 / $120.80 / $279.35	Professional		$59.00	$120.80	$279.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.50 / $50.40 / $83.85	Professional	26	$21.50	$50.40	$83.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $51.50 / $107.00 / $210.60	Professional	TC	$51.50	$107.00	$210.60
United Facility/Professional Professional Modifier Low / Median / High Price $88.07 / $125.70 / $213.69	Professional		$88.07	$125.70	$213.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.94 / $42.92 / $72.95	Professional	26	$24.94	$42.92	$72.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.69 / $82.78 / $140.72	Professional	TC	$59.69	$82.78	$140.72