Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $160.40 / $285.27 / $401.55	Facility	26	$160.40	$285.27	$401.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $221.75 / $272.73 / $687.35	Professional		$221.75	$272.73	$687.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.14 / $67.00 / $228.23	Professional	26	$44.14	$67.00	$228.23
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $270.37 / $270.37 / $289.74	Professional	52	$270.37	$270.37	$289.74
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $177.61 / $221.14 / $370.82	Professional	TC	$177.61	$221.14	$370.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $203.08 / $487.91 / $700.00	Professional		$203.08	$487.91	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.02 / $155.80 / $210.00	Professional	26	$77.02	$155.80	$210.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.06 / $311.87 / $490.00	Professional	TC	$126.06	$311.87	$490.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $327.50 / $396.02 / $900.00	Professional		$327.50	$396.02	$900.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $122.93 / $150.75 / $372.13	Professional	26	$122.93	$150.75	$372.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $189.87 / $245.52 / $499.46	Professional	TC	$189.87	$245.52	$499.46
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $506.25 / $587.25 / $994.58	Professional		$506.25	$587.25	$994.58
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $190.00 / $215.80 / $366.54	Professional	26	$190.00	$215.80	$366.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $316.25 / $388.50 / $628.04	Professional	TC	$316.25	$388.50	$628.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.32 / $511.25 / $932.97	Professional		$193.32	$511.25	$932.97
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $144.00 / $246.00 / $366.54	Professional	26	$144.00	$246.00	$366.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $321.25 / $421.50 / $628.04	Professional	TC	$321.25	$421.50	$628.04
United Facility/Professional Professional Modifier Low / Median / High Price $389.10 / $486.38 / $929.95	Professional		$389.10	$486.38	$929.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.00 / $244.02 / $388.81	Professional	26	$79.00	$244.02	$388.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $226.41 / $339.63 / $541.14	Professional	TC	$226.41	$339.63	$541.14