Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.05 / $78.05 / $78.05	Facility	26	$78.05	$78.05	$78.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $59.83 / $70.37 / $151.22	Professional		$59.83	$70.37	$151.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $27.75 / $30.85 / $79.77	Professional	26	$27.75	$30.85	$79.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.03 / $39.52 / $85.51	Professional	TC	$33.03	$39.52	$85.51
Cigna Facility/Professional Professional Modifier Low / Median / High Price $57.48 / $92.88 / $188.33	Professional		$57.48	$92.88	$188.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.45 / $43.40 / $95.13	Professional	26	$26.45	$43.40	$95.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.13 / $49.48 / $93.21	Professional	TC	$30.13	$49.48	$93.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.89 / $184.38 / $314.20	Professional		$87.89	$184.38	$314.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.68 / $78.59 / $153.60	Professional	26	$51.68	$78.59	$153.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.70 / $102.06 / $160.65	Professional	TC	$56.70	$102.06	$160.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $96.03 / $211.25 / $338.00	Professional		$96.03	$211.25	$338.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $46.58 / $98.40 / $148.22	Professional	26	$46.58	$98.40	$148.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $49.45 / $108.75 / $177.40	Professional	TC	$49.45	$108.75	$177.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.23 / $162.96 / $318.20	Professional		$74.23	$162.96	$318.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.50 / $96.15 / $159.90	Professional	26	$40.50	$96.15	$159.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.80 / $103.20 / $175.21	Professional	TC	$45.80	$103.20	$175.21
United Facility/Professional Professional Modifier Low / Median / High Price $82.78 / $153.69 / $324.52	Professional		$82.78	$153.69	$324.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.51 / $81.23 / $192.95	Professional	26	$27.51	$81.23	$192.95
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.02 / $72.09 / $164.06	Professional	TC	$37.02	$72.09	$164.06