Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.86 / $25.41 / $25.41	Facility	26	$24.86	$25.41	$25.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $55.96 / $64.72 / $143.66	Professional		$55.96	$64.72	$143.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.19 / $12.38 / $45.69	Professional	26	$8.19	$12.38	$45.69
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $27.98 / $38.42 / $54.80	Professional	52	$27.98	$38.42	$54.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $47.17 / $55.95 / $122.86	Professional	TC	$47.17	$55.95	$122.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.92 / $84.73 / $167.21	Professional		$52.92	$84.73	$167.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.48 / $13.76 / $30.00	Professional	26	$8.48	$13.76	$30.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $44.43 / $70.98 / $137.21	Professional	TC	$44.43	$70.98	$137.21
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $87.23 / $163.02 / $259.25	Professional		$87.23	$163.02	$259.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.27 / $25.23 / $48.92	Professional	26	$17.27	$25.23	$48.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $74.23 / $133.13 / $210.33	Professional	TC	$74.23	$133.13	$210.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $91.43 / $194.04 / $307.44	Professional		$91.43	$194.04	$307.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $14.95 / $31.20 / $49.00	Professional	26	$14.95	$31.20	$49.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.48 / $161.28 / $258.00	Professional	TC	$76.48	$161.28	$258.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $67.88 / $155.44 / $294.50	Professional		$67.88	$155.44	$294.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.70 / $28.60 / $50.70	Professional	26	$11.70	$28.60	$50.70
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $66.50 / $151.19 / $251.55	Professional	TC	$66.50	$151.19	$251.55
United Facility/Professional Professional Modifier Low / Median / High Price $80.00 / $132.88 / $286.87	Professional		$80.00	$132.88	$286.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $25.88 / $55.87	Professional	26	$8.83	$25.88	$55.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.46 / $107.00 / $296.72	Professional	TC	$48.46	$107.00	$296.72