Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.07 / $50.07 / $50.07	Facility	26	$50.07	$50.07	$50.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $68.20 / $78.26 / $214.29	Professional		$68.20	$78.26	$214.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.21 / $24.28 / $50.07	Professional	26	$20.21	$24.28	$50.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.72 / $53.98 / $75.45	Professional	TC	$47.72	$53.98	$75.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.45 / $85.60 / $164.59	Professional		$50.45	$85.60	$164.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.97 / $26.12 / $65.14	Professional	26	$17.97	$26.12	$65.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.47 / $49.43 / $99.45	Professional	TC	$32.47	$49.43	$99.45
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $95.10 / $145.56 / $214.80	Professional		$95.10	$145.56	$214.80
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.05 / $50.46 / $118.47	Professional	26	$42.05	$50.46	$118.47
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $78.45 / $95.10 / $177.96	Professional	TC	$78.45	$95.10	$177.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $168.30 / $205.20 / $280.86	Professional		$168.30	$205.20	$280.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $56.16 / $70.20 / $95.16	Professional	26	$56.16	$70.20	$95.16
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $110.16 / $135.00 / $179.34	Professional	TC	$110.16	$135.00	$179.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $64.40 / $150.71 / $275.39	Professional		$64.40	$150.71	$275.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.56 / $78.00 / $100.05	Professional	26	$33.56	$78.00	$100.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $52.04 / $146.44 / $190.48	Professional	TC	$52.04	$146.44	$190.48
United Facility/Professional Professional Modifier Low / Median / High Price $111.12 / $131.66 / $238.12	Professional		$111.12	$131.66	$238.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $28.01 / $52.10 / $84.66	Professional	26	$28.01	$52.10	$84.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.22 / $79.56 / $129.29	Professional	TC	$75.22	$79.56	$129.29