Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Facility	26	$51.29	$51.29	$51.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $67.61 / $158.49	Professional		$51.29	$67.61	$158.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.85 / $18.20 / $33.11	Professional	26	$15.85	$18.20	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $34.67 / $45.71 / $75.86	Professional	TC	$34.67	$45.71	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $151.36 / $190.55	Professional		$123.03	$151.36	$190.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $48.98 / $64.57	Professional	26	$42.66	$48.98	$64.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $104.71 / $125.89	Professional	TC	$79.43	$104.71	$125.89
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $162.18 / $275.42	Professional		$61.66	$162.18	$275.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $53.70 / $91.20	Professional	26	$18.20	$53.70	$91.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $114.82 / $186.21	Professional	TC	$42.66	$114.82	$186.21
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $251.19 / $331.13	Professional		$112.20	$251.19	$331.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $72.44 / $97.72	Professional	26	$36.31	$72.44	$97.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $177.83 / $229.09	Professional	TC	$75.86	$177.83	$229.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $151.36 / $190.55	Professional		$70.79	$151.36	$190.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.78 / $32.36 / $64.57	Professional	26	$17.78	$32.36	$64.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $79.43 / $128.82	Professional	TC	$39.81	$79.43	$128.82
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $151.36 / $331.13	Professional		$70.79	$151.36	$331.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.30 / $52.48 / $112.20	Professional	26	$26.30	$52.48	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $100.00 / $213.80	Professional	TC	$48.98	$100.00	$213.80