Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.46 / $62.46 / $62.46	Facility	26	$62.46	$62.46	$62.46
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.32 / $40.56 / $82.23	Professional		$33.32	$40.56	$82.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.00 / $25.76 / $52.25	Professional	26	$22.00	$25.76	$52.25
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $16.28 / $22.70 / $36.36	Professional	52	$16.28	$22.70	$36.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $11.54 / $14.29 / $29.98	Professional	TC	$11.54	$14.29	$29.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $31.26 / $51.95 / $105.85	Professional		$31.26	$51.95	$105.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.22 / $34.45 / $75.37	Professional	26	$21.22	$34.45	$75.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $10.09 / $17.50 / $30.48	Professional	TC	$10.09	$17.50	$30.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $47.31 / $99.96 / $178.71	Professional		$47.31	$99.96	$178.71
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.38 / $63.09 / $122.91	Professional	26	$43.38	$63.09	$122.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $19.70 / $35.32 / $55.80	Professional	TC	$19.70	$35.32	$55.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $55.05 / $116.40 / $188.49	Professional		$55.05	$116.40	$188.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.89 / $78.00 / $118.95	Professional	26	$36.89	$78.00	$118.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $18.16 / $38.40 / $62.40	Professional	TC	$18.16	$38.40	$62.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $40.40 / $88.05 / $179.45	Professional		$40.40	$88.05	$179.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.25 / $71.50 / $126.75	Professional	26	$29.25	$71.50	$126.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $16.00 / $37.52 / $61.84	Professional	TC	$16.00	$37.52	$61.84
United Facility/Professional Professional Modifier Low / Median / High Price $34.99 / $88.90 / $211.14	Professional		$34.99	$88.90	$211.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.94 / $65.02 / $140.37	Professional	26	$21.94	$65.02	$140.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.97 / $23.88 / $47.76	Professional	TC	$16.97	$23.88	$47.76