Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $157.49 / $356.47 / $356.47	Professional		$157.49	$356.47	$356.47
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.88 / $94.79 / $94.79	Professional	26	$41.88	$94.79	$94.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $115.60 / $261.67 / $261.67	Professional	TC	$115.60	$261.67	$261.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.78 / $107.78 / $107.78	Professional		$107.78	$107.78	$107.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.38 / $30.38 / $30.38	Professional	26	$30.38	$30.38	$30.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.40 / $77.40 / $77.40	Professional	TC	$77.40	$77.40	$77.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $205.30 / $205.30 / $449.75	Professional		$205.30	$205.30	$449.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.37 / $56.37 / $56.37	Professional	26	$56.37	$56.37	$56.37
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $148.93 / $148.93 / $148.93	Professional	TC	$148.93	$148.93	$148.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.79 / $321.25 / $470.31	Professional		$102.79	$321.25	$470.31
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.18 / $72.50 / $106.14	Professional	26	$30.18	$72.50	$106.14
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.61 / $248.75 / $364.17	Professional	TC	$72.61	$248.75	$364.17
Providence Facility/Professional Professional Modifier Low / Median / High Price $107.78 / $332.50 / $447.70	Professional		$107.78	$332.50	$447.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.38 / $73.75 / $122.10	Professional	26	$30.38	$73.75	$122.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $77.40 / $258.75 / $343.50	Professional	TC	$77.40	$258.75	$343.50
United Facility/Professional Professional Modifier Low / Median / High Price $348.06 / $348.06 / $348.06	Professional		$348.06	$348.06	$348.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $95.58 / $95.58 / $95.58	Professional	26	$95.58	$95.58	$95.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $252.48 / $252.48 / $252.48	Professional	TC	$252.48	$252.48	$252.48