Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $185.10 / $185.10 / $185.10	Facility	26	$185.10	$185.10	$185.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $347.48 / $427.97 / $786.03	Professional		$347.48	$427.97	$786.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.34 / $69.23 / $263.37	Professional	26	$59.34	$69.23	$263.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $288.12 / $358.73 / $522.66	Professional	TC	$288.12	$358.73	$522.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $299.22 / $731.65 / $973.00	Professional		$299.22	$731.65	$973.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $89.29 / $204.40 / $276.00	Professional	26	$89.29	$204.40	$276.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $209.93 / $527.24 / $681.10	Professional	TC	$209.93	$527.24	$681.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $482.52 / $579.33 / $1,263.13	Professional		$482.52	$579.33	$1,263.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $142.33 / $174.44 / $429.72	Professional	26	$142.33	$174.44	$429.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $315.81 / $408.54 / $833.42	Professional	TC	$315.81	$408.54	$833.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $746.25 / $865.65 / $1,459.46	Professional		$746.25	$865.65	$1,459.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $220.00 / $256.10 / $435.83	Professional	26	$220.00	$256.10	$435.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $526.25 / $619.00 / $1,023.63	Professional	TC	$526.25	$619.00	$1,023.63
Providence Facility/Professional Professional Modifier Low / Median / High Price $280.16 / $814.00 / $1,396.05	Professional		$280.16	$814.00	$1,396.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $210.87 / $292.50 / $435.83	Professional	26	$210.87	$292.50	$435.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $536.25 / $687.00 / $1,023.63	Professional	TC	$536.25	$687.00	$1,023.63
United Facility/Professional Professional Modifier Low / Median / High Price $562.67 / $844.02 / $1,261.95	Professional		$562.67	$844.02	$1,261.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.88 / $290.13 / $462.28	Professional	26	$93.88	$290.13	$462.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $369.26 / $553.89 / $882.53	Professional	TC	$369.26	$553.89	$882.53