Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $291.33 / $659.46 / $659.46	Professional		$291.33	$659.46	$659.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $173.00 / $173.01 / $413.60	Professional	26	$173.00	$173.01	$413.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.91 / $486.45 / $486.45	Professional	TC	$214.91	$486.45	$486.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $136.22 / $136.22 / $136.22	Professional		$136.22	$136.22	$136.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.74 / $49.74 / $49.74	Professional	26	$49.74	$49.74	$49.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $86.49 / $86.49 / $86.49	Professional	TC	$86.49	$86.49	$86.49
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $410.44 / $410.44 / $904.75	Professional		$410.44	$410.44	$904.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.30 / $106.30 / $106.30	Professional	26	$106.30	$106.30	$106.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $304.14 / $304.14 / $304.14	Professional	TC	$304.14	$304.14	$304.14
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $154.18 / $646.25 / $946.11	Professional		$154.18	$646.25	$946.11
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $52.81 / $140.00 / $204.96	Professional	26	$52.81	$140.00	$204.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $101.37 / $506.25 / $741.15	Professional	TC	$101.37	$506.25	$741.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $136.22 / $648.75 / $917.60	Professional		$136.22	$648.75	$917.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.74 / $138.75 / $210.90	Professional	26	$49.74	$138.75	$210.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $86.49 / $510.00 / $706.70	Professional	TC	$86.49	$510.00	$706.70
United Facility/Professional Professional Modifier Low / Median / High Price $619.14 / $619.14 / $619.14	Professional		$619.14	$619.14	$619.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $165.72 / $165.72 / $165.72	Professional	26	$165.72	$165.72	$165.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $453.42 / $453.42 / $453.42	Professional	TC	$453.42	$453.42	$453.42