Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $25.70 / $25.70	Facility	26	$25.12	$25.70	$25.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $63.10 / $120.23	Professional		$47.86	$63.10	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $8.91 / $19.95	Professional	26	$7.08	$8.91	$19.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $50.12 / $95.50	Professional	TC	$39.81	$50.12	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $75.86 / $165.96	Professional		$52.48	$75.86	$165.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.51 / $11.75 / $30.20	Professional	26	$8.51	$11.75	$30.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $64.57 / $138.04	Professional	TC	$44.67	$64.57	$138.04
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $25.70 / $25.70	Facility	26	$25.70	$25.70	$25.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $154.88 / $263.03	Professional		$77.62	$154.88	$263.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $12.02 / $26.92 / $46.77	Professional	26	$12.02	$26.92	$46.77
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $128.82 / $213.80	Professional	TC	$77.62	$128.82	$213.80
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $199.53 / $302.00	Professional		$102.33	$199.53	$302.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.98 / $32.36 / $47.86	Professional	26	$16.98	$32.36	$47.86
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $165.96 / $251.19	Professional	TC	$87.10	$165.96	$251.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $75.86 / $165.96	Professional		$53.70	$75.86	$165.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $11.48 / $32.36	Professional	26	$8.71	$11.48	$32.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $61.66 / $151.36	Professional	TC	$44.67	$61.66	$151.36
United Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $131.83 / $288.40	Professional		$50.12	$131.83	$288.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.32 / $25.70 / $56.23	Professional	26	$8.32	$25.70	$56.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $107.15 / $229.09	Professional	TC	$41.69	$107.15	$229.09