Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $245.47 / $245.47 / $245.47	Facility	26	$245.47	$245.47	$245.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $338.84 / $1,000.00	Professional		$218.78	$338.84	$1,000.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $93.33 / $323.59	Professional	26	$66.07	$93.33	$323.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $549.54	Professional	TC	$144.54	$218.78	$549.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $851.14 / $977.24	Professional		$741.31	$851.14	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $263.03 / $295.12	Professional	26	$134.90	$263.03	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $630.96 / $676.08	Professional	TC	$457.09	$630.96	$676.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $416.87 / $630.96 / $1,174.90	Professional		$416.87	$630.96	$1,174.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.03 / $223.87 / $446.68	Professional	26	$123.03	$223.87	$446.68
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $398.11 / $630.96	Professional	TC	$331.13	$398.11	$630.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.76 / $954.99 / $1,548.82	Professional		$831.76	$954.99	$1,548.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $309.03 / $489.78	Professional	26	$269.15	$309.03	$489.78
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $575.44 / $645.65 / $1,023.29	Professional	TC	$575.44	$645.65	$1,023.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $562.34 / $851.14	Professional		$323.59	$562.34	$851.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $223.87 / $295.12	Professional	26	$64.57	$223.87	$295.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $457.09 / $676.08	Professional	TC	$151.36	$457.09	$676.08
United Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $891.25 / $1,949.84	Professional		$588.84	$891.25	$1,949.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $194.98 / $338.84 / $741.31	Professional	26	$194.98	$338.84	$741.31
United Facility/Professional Professional Modifier TC Low / Median / High Price $371.54 / $562.34 / $1,445.44	Professional	TC	$371.54	$562.34	$1,445.44