Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.13 / $280.98 / $280.98	Professional		$124.13	$280.98	$280.98
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.57 / $123.52 / $123.52	Professional	26	$54.57	$123.52	$123.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $157.46 / $157.46	Professional	TC	$69.56	$157.46	$157.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.25 / $63.25 / $63.25	Professional		$63.25	$63.25	$63.25
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.85 / $37.85 / $37.85	Professional	26	$37.85	$37.85	$37.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.41 / $25.41 / $25.41	Professional	TC	$25.41	$25.41	$25.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $195.74 / $195.74 / $420.00	Professional		$195.74	$195.74	$420.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.88 / $76.88 / $76.88	Professional	26	$76.88	$76.88	$76.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $118.85 / $118.85 / $118.85	Professional	TC	$118.85	$118.85	$118.85
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.60 / $289.50 / $439.20	Professional		$97.60	$289.50	$439.20
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $101.25 / $148.22	Professional	26	$38.65	$101.25	$148.22
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $58.94 / $171.00 / $290.97	Professional	TC	$58.94	$171.00	$290.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $63.25 / $283.75 / $381.10	Professional		$63.25	$283.75	$381.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.85 / $100.00 / $153.55	Professional	26	$37.85	$100.00	$153.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.41 / $171.00 / $227.55	Professional	TC	$25.41	$171.00	$227.55
United Facility/Professional Professional Modifier Low / Median / High Price $255.78 / $255.78 / $255.78	Professional		$255.78	$255.78	$255.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $120.72 / $120.72 / $120.72	Professional	26	$120.72	$120.72	$120.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $135.06 / $135.06 / $135.06	Professional	TC	$135.06	$135.06	$135.06