Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $149.01 / $167.25 / $243.10	Professional		$149.01	$167.25	$243.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.09 / $18.92 / $33.88	Professional	26	$16.09	$18.92	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $132.91 / $148.33 / $209.22	Professional	TC	$132.91	$148.33	$209.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $80.67 / $124.23 / $315.33	Professional		$80.67	$124.23	$315.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.68 / $15.37 / $54.55	Professional	26	$11.68	$15.37	$54.55
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.98 / $106.35 / $260.77	Professional	TC	$68.98	$106.35	$260.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $202.95 / $384.27 / $425.76	Professional		$202.95	$384.27	$425.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.40 / $42.69 / $44.07	Professional	26	$27.40	$42.69	$44.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $175.55 / $330.19 / $341.58	Professional	TC	$175.55	$330.19	$341.58
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $157.50 / $207.20 / $537.29	Professional		$157.50	$207.20	$537.29
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $21.00 / $30.10 / $59.40	Professional	26	$21.00	$30.10	$59.40
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $136.00 / $177.10 / $477.90	Professional	TC	$136.00	$177.10	$477.90
Providence Facility/Professional Professional Modifier Low / Median / High Price $126.63 / $185.00 / $472.50	Professional		$126.63	$185.00	$472.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $17.20 / $29.67 / $64.50	Professional	26	$17.20	$29.67	$64.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.21 / $174.57 / $408.00	Professional	TC	$112.21	$174.57	$408.00
United Facility/Professional Professional Modifier Low / Median / High Price $81.12 / $250.75 / $290.01	Professional		$81.12	$250.75	$290.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.86 / $37.81 / $42.36	Professional	26	$13.86	$37.81	$42.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.31 / $218.84 / $248.02	Professional	TC	$79.31	$218.84	$248.02