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 $38.79 / $45.92 / $101.28	Professional		$38.79	$45.92	$101.28
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.22 / $15.91 / $33.96	Professional	26	$14.22	$15.91	$33.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.69 / $30.00 / $67.31	Professional	TC	$24.69	$30.00	$67.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $35.59 / $61.30 / $120.82	Professional		$35.59	$61.30	$120.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.71 / $22.30 / $48.82	Professional	26	$13.71	$22.30	$48.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $22.42 / $39.00 / $68.18	Professional	TC	$22.42	$39.00	$68.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.20 / $109.77 / $190.40	Professional		$53.20	$109.77	$190.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $26.78 / $40.77 / $79.59	Professional	26	$26.78	$40.77	$79.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.28 / $60.65 / $110.80	Professional	TC	$37.28	$60.65	$110.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.25 / $140.00 / $214.11	Professional		$63.25	$140.00	$214.11
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $24.15 / $50.40 / $76.86	Professional	26	$24.15	$50.40	$76.86
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $39.10 / $87.50 / $137.25	Professional	TC	$39.10	$87.50	$137.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.98 / $101.70 / $209.05	Professional		$45.98	$101.70	$209.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $18.89 / $48.82 / $81.90	Professional	26	$18.89	$48.82	$81.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $34.00 / $78.25 / $138.07	Professional	TC	$34.00	$78.25	$138.07
United Facility/Professional Professional Modifier Low / Median / High Price $36.02 / $96.66 / $208.67	Professional		$36.02	$96.66	$208.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.27 / $42.12 / $100.04	Professional	26	$14.27	$42.12	$100.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.40 / $56.80 / $117.74	Professional	TC	$24.40	$56.80	$117.74