Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.69 / $34.44 / $34.44	Facility	26	$33.69	$34.44	$34.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.63 / $64.29 / $143.36	Professional		$52.63	$64.29	$143.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.85 / $16.78 / $49.60	Professional	26	$11.85	$16.78	$49.60
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $26.12 / $35.88 / $53.26	Professional	52	$26.12	$35.88	$53.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.39 / $51.06 / $115.19	Professional	TC	$41.39	$51.06	$115.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $49.29 / $85.12 / $160.44	Professional		$49.29	$85.12	$160.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.43 / $18.55 / $40.67	Professional	26	$11.43	$18.55	$40.67
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.24 / $66.56 / $117.13	Professional	TC	$38.24	$66.56	$117.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.20 / $164.97 / $265.58	Professional		$72.20	$164.97	$265.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.40 / $33.96 / $66.30	Professional	26	$23.40	$33.96	$66.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $70.34 / $109.18 / $199.28	Professional	TC	$70.34	$109.18	$199.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.83 / $187.74 / $311.10	Professional		$86.83	$187.74	$311.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $19.86 / $42.00 / $64.05	Professional	26	$19.86	$42.00	$64.05
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.70 / $145.19 / $235.95	Professional	TC	$66.70	$145.19	$235.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.05 / $144.66 / $292.56	Professional		$67.05	$144.66	$292.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $15.75 / $38.50 / $68.25	Professional	26	$15.75	$38.50	$68.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $59.44 / $136.80 / $235.81	Professional	TC	$59.44	$136.80	$235.81
United Facility/Professional Professional Modifier Low / Median / High Price $54.90 / $132.04 / $277.11	Professional		$54.90	$132.04	$277.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.10 / $35.08 / $70.16	Professional	26	$19.10	$35.08	$70.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.95 / $93.28 / $201.38	Professional	TC	$83.95	$93.28	$201.38