Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $239.88 / $302.00	Facility	26	$169.82	$239.88	$302.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $275.42 / $616.60	Professional		$165.96	$275.42	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $81.28 / $223.87	Professional	26	$53.70	$81.28	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $194.98 / $426.58	Professional	TC	$109.65	$194.98	$426.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $512.86 / $741.31 / $831.76	Professional		$512.86	$741.31	$831.76
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $199.53 / $245.47	Professional	26	$104.71	$199.53	$245.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $309.03 / $537.03 / $575.44	Professional	TC	$309.03	$537.03	$575.44
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $169.82 / $239.88 / $416.87	Facility	26	$169.82	$239.88	$416.87
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $436.52 / $707.95	Professional		$275.42	$436.52	$707.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $158.49 / $251.19	Professional	26	$83.18	$158.49	$251.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $199.53 / $269.15 / $489.78	Professional	TC	$199.53	$269.15	$489.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $660.69 / $1,047.13	Professional		$588.84	$660.69	$1,047.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $213.80 / $354.81	Professional	26	$199.53	$213.80	$354.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $389.05 / $436.52 / $691.83	Professional	TC	$389.05	$436.52	$691.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $223.87 / $389.05 / $741.31	Professional		$223.87	$389.05	$741.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $181.97 / $245.47	Professional	26	$44.67	$181.97	$245.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $309.03 / $575.44	Professional	TC	$102.33	$309.03	$575.44
United Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $616.60 / $1,862.09	Professional		$407.38	$616.60	$1,862.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $138.04 / $234.42 / $724.44	Professional	26	$138.04	$234.42	$724.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $371.54 / $1,174.90	Professional	TC	$251.19	$371.54	$1,174.90