Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.87 / $171.47 / $298.56	Facility	26	$167.87	$171.47	$298.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $232.72 / $285.94 / $598.30	Professional		$232.72	$285.94	$598.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.57 / $56.66 / $238.85	Professional	26	$48.57	$56.66	$238.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $184.15 / $229.28 / $359.46	Professional	TC	$184.15	$229.28	$359.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $226.86 / $499.47 / $584.67	Professional		$226.86	$499.47	$584.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.45 / $172.33 / $198.28	Professional	26	$80.45	$172.33	$198.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $146.40 / $301.19 / $412.35	Professional	TC	$146.40	$301.19	$412.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $365.53 / $439.26 / $966.85	Professional		$365.53	$439.26	$966.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.58 / $157.77 / $389.51	Professional	26	$128.58	$157.77	$389.51
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $219.60 / $284.33 / $577.34	Professional	TC	$219.60	$284.33	$577.34
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $565.00 / $615.60 / $1,025.86	Professional		$565.00	$615.60	$1,025.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $198.75 / $214.65 / $357.60	Professional	26	$198.75	$214.65	$357.60
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $366.25 / $400.95 / $668.27	Professional	TC	$366.25	$400.95	$668.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $214.45 / $570.00 / $970.20	Professional		$214.45	$570.00	$970.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $172.33 / $240.00 / $357.60	Professional	26	$172.33	$240.00	$357.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $358.80 / $448.50 / $668.27	Professional	TC	$358.80	$448.50	$668.27
United Facility/Professional Professional Modifier Low / Median / High Price $399.58 / $599.37 / $955.00	Professional		$399.58	$599.37	$955.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $137.47 / $158.62 / $352.75	Professional	26	$137.47	$158.62	$352.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $240.96 / $361.44 / $575.89	Professional	TC	$240.96	$361.44	$575.89