Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.48 / $507.74 / $994.78	Facility	26	$93.48	$507.74	$994.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $324.04 / $522.50 / $1,070.41	Professional		$324.04	$522.50	$1,070.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $108.44 / $154.00 / $456.00	Professional	26	$108.44	$154.00	$456.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $422.85 / $535.21 / $535.21	Professional	52	$422.85	$535.21	$535.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $325.86 / $368.50 / $638.79	Professional	TC	$325.86	$368.50	$638.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $292.08 / $712.03 / $900.00	Professional		$292.08	$712.03	$900.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.97 / $242.69 / $270.00	Professional	26	$105.97	$242.69	$270.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $186.11 / $469.35 / $630.00	Professional	TC	$186.11	$469.35	$630.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $470.65 / $566.46 / $1,479.01	Professional		$470.65	$566.46	$1,479.01
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $169.00 / $207.07 / $511.50	Professional	26	$169.00	$207.07	$511.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.74 / $361.95 / $739.97	Professional	TC	$279.74	$361.95	$739.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $727.50 / $821.60 / $1,367.82	Professional		$727.50	$821.60	$1,367.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $261.25 / $282.14 / $477.00	Professional	26	$261.25	$282.14	$477.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $466.25 / $540.85 / $899.68	Professional	TC	$466.25	$540.85	$899.68
Providence Facility/Professional Professional Modifier Low / Median / High Price $277.58 / $778.75 / $1,337.70	Professional		$277.58	$778.75	$1,337.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $227.78 / $316.50 / $471.59	Professional	26	$227.78	$316.50	$471.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $474.00 / $629.17 / $896.24	Professional	TC	$474.00	$629.17	$896.24
United Facility/Professional Professional Modifier Low / Median / High Price $531.70 / $797.55 / $1,129.85	Professional		$531.70	$797.55	$1,129.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.15 / $260.55 / $442.94	Professional	26	$76.15	$260.55	$442.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.26 / $484.89 / $736.39	Professional	TC	$323.26	$484.89	$736.39