Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.93 / $314.45 / $314.45	Professional		$138.93	$314.45	$314.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.87 / $54.04 / $274.48	Professional	26	$23.87	$54.04	$274.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $115.06 / $260.42 / $260.42	Professional	TC	$115.06	$260.42	$260.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $63.43 / $63.43 / $63.43	Professional		$63.43	$63.43	$63.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.13 / $16.13 / $16.13	Professional	26	$16.13	$16.13	$16.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.30 / $47.30 / $47.30	Professional	TC	$47.30	$47.30	$47.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $21.00 / $126.10 / $430.50	Professional		$21.00	$126.10	$430.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.96 / $32.96 / $32.96	Professional	26	$32.96	$32.96	$32.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $158.28 / $158.28 / $158.28	Professional	TC	$158.28	$158.28	$158.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $86.76 / $307.50 / $450.18	Professional		$86.76	$307.50	$450.18
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $16.03 / $43.75 / $64.05	Professional	26	$16.03	$43.75	$64.05
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.73 / $263.75 / $386.13	Professional	TC	$70.73	$263.75	$386.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $63.43 / $311.25 / $370.00	Professional		$63.43	$311.25	$370.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $16.13 / $43.75 / $64.75	Professional	26	$16.13	$43.75	$64.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $47.30 / $267.50 / $305.25	Professional	TC	$47.30	$267.50	$305.25
United Facility/Professional Professional Modifier Low / Median / High Price $267.95 / $267.95 / $267.95	Professional		$267.95	$267.95	$267.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.81 / $51.81 / $51.81	Professional	26	$51.81	$51.81	$51.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $216.15 / $216.15 / $216.15	Professional	TC	$216.15	$216.15	$216.15