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 / $417.81	Facility	26	$167.87	$298.56	$417.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $287.22 / $353.25 / $613.96	Professional		$287.22	$353.25	$613.96
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.06 / $75.61 / $238.85	Professional	26	$56.06	$75.61	$238.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $231.15 / $287.80 / $375.11	Professional	TC	$231.15	$287.80	$375.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $232.32 / $510.56 / $737.64	Professional		$232.32	$510.56	$737.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $80.45 / $183.06 / $198.77	Professional	26	$80.45	$183.06	$198.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.86 / $312.29 / $538.87	Professional	TC	$151.86	$312.29	$538.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $374.40 / $449.28 / $1,016.00	Professional		$374.40	$449.28	$1,016.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $128.58 / $157.77 / $387.59	Professional	26	$128.58	$157.77	$387.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $227.86 / $294.99 / $601.76	Professional	TC	$227.86	$294.99	$601.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $578.75 / $659.40 / $1,050.45	Professional		$578.75	$659.40	$1,050.45
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 $380.00 / $435.40 / $692.85	Professional	TC	$380.00	$435.40	$692.85
Providence Facility/Professional Professional Modifier Low / Median / High Price $219.43 / $585.00 / $995.40	Professional		$219.43	$585.00	$995.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $192.00 / $240.00 / $357.60	Professional	26	$192.00	$240.00	$357.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $374.40 / $471.00 / $692.85	Professional	TC	$374.40	$471.00	$692.85
United Facility/Professional Professional Modifier Low / Median / High Price $408.46 / $615.45 / $976.22	Professional		$408.46	$615.45	$976.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.93 / $237.12 / $379.10	Professional	26	$88.93	$237.12	$379.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $249.84 / $374.76 / $597.12	Professional	TC	$249.84	$374.76	$597.12