Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.83 / $8.83 / $8.83	Facility	26	$8.83	$8.83	$8.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.53 / $40.92 / $137.83	Professional		$37.53	$40.92	$137.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.79 / $4.21 / $12.50	Professional	26	$3.79	$4.21	$12.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $18.77 / $25.02 / $45.03	Professional	52	$18.77	$25.02	$45.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.33 / $37.11 / $61.65	Professional	TC	$33.33	$37.11	$61.65
Cigna Facility/Professional Professional Modifier Low / Median / High Price $23.41 / $38.40 / $73.02	Professional		$23.41	$38.40	$73.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $3.15 / $5.16 / $11.49	Professional	26	$3.15	$5.16	$11.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $20.26 / $29.94 / $61.53	Professional	TC	$20.26	$29.94	$61.53
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.17 / $66.00 / $129.99	Professional		$53.17	$66.00	$129.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $7.28 / $8.82 / $20.96	Professional	26	$7.28	$8.82	$20.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.45 / $57.24 / $109.03	Professional	TC	$47.45	$57.24	$109.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $80.30 / $94.90 / $130.19	Professional		$80.30	$94.90	$130.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.72 / $12.15 / $16.47	Professional	26	$9.72	$12.15	$16.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $69.12 / $82.35 / $112.00	Professional	TC	$69.12	$82.35	$112.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $30.64 / $70.92 / $129.60	Professional		$30.64	$70.92	$129.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $5.92 / $13.50 / $17.32	Professional	26	$5.92	$13.50	$17.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $32.46 / $91.35 / $118.40	Professional	TC	$32.46	$91.35	$118.40
United Facility/Professional Professional Modifier Low / Median / High Price $55.50 / $58.42 / $105.66	Professional		$55.50	$58.42	$105.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $5.34 / $9.19 / $16.64	Professional	26	$5.34	$9.19	$16.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $49.22 / $49.22 / $89.02	Professional	TC	$49.22	$49.22	$89.02