Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $167.87 / $298.56 / $438.58	Facility	26	$167.87	$298.56	$438.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $332.37 / $409.21 / $721.78	Professional		$332.37	$409.21	$721.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.50 / $69.47 / $238.85	Professional	26	$59.50	$69.47	$238.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $272.87 / $339.73 / $482.92	Professional	TC	$272.87	$339.73	$482.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $275.00 / $670.95 / $858.10	Professional		$275.00	$670.95	$858.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.45 / $183.06 / $247.50	Professional	26	$80.45	$183.06	$247.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $194.54 / $486.76 / $646.70	Professional	TC	$194.54	$486.76	$646.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $443.27 / $532.74 / $1,160.67	Professional		$443.27	$532.74	$1,160.67
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 $292.51 / $378.45 / $771.10	Professional	TC	$292.51	$378.45	$771.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $686.25 / $970.00 / $1,405.82	Professional		$686.25	$970.00	$1,405.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $198.75 / $246.25 / $383.51	Professional	26	$198.75	$246.25	$383.51
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $487.50 / $713.70 / $1,048.22	Professional	TC	$487.50	$713.70	$1,048.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $258.02 / $784.00 / $1,405.82	Professional		$258.02	$784.00	$1,405.82
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $194.05 / $247.50 / $394.00	Professional	26	$194.05	$247.50	$394.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $496.25 / $703.50 / $1,166.00	Professional	TC	$496.25	$703.50	$1,166.00
United Facility/Professional Professional Modifier Low / Median / High Price $482.88 / $805.14 / $1,464.57	Professional		$482.88	$805.14	$1,464.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.88 / $237.93 / $429.05	Professional	26	$93.88	$237.93	$429.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $345.40 / $567.21 / $1,035.52	Professional	TC	$345.40	$567.21	$1,035.52