Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $161.56 / $287.35 / $345.56	Facility	26	$161.56	$287.35	$345.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $220.65 / $271.06 / $580.85	Professional		$220.65	$271.06	$580.85
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.78 / $58.14 / $229.88	Professional	26	$46.78	$58.14	$229.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $173.87 / $216.49 / $311.30	Professional	TC	$173.87	$216.49	$311.30
Cigna Facility/Professional Professional Modifier Low / Median / High Price $203.08 / $475.46 / $700.00	Professional		$203.08	$475.46	$700.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $77.51 / $165.86 / $210.00	Professional	26	$77.51	$165.86	$210.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $125.56 / $311.87 / $490.00	Professional	TC	$125.56	$311.87	$490.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $327.50 / $396.37 / $872.36	Professional		$327.50	$396.37	$872.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $123.73 / $148.47 / $374.83	Professional	26	$123.73	$148.47	$374.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $189.11 / $244.53 / $497.53	Professional	TC	$189.11	$244.53	$497.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $506.25 / $552.15 / $914.12	Professional		$506.25	$552.15	$914.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $191.25 / $206.55 / $344.19	Professional	26	$191.25	$206.55	$344.19
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $315.00 / $345.60 / $569.92	Professional	TC	$315.00	$345.60	$569.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.49 / $511.25 / $867.30	Professional		$193.49	$511.25	$867.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $154.00 / $231.00 / $344.19	Professional	26	$154.00	$231.00	$344.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $310.80 / $382.50 / $569.92	Professional	TC	$310.80	$382.50	$569.92
United Facility/Professional Professional Modifier Low / Median / High Price $358.12 / $537.17 / $855.91	Professional		$358.12	$537.17	$855.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $132.33 / $152.68 / $339.54	Professional	26	$132.33	$152.68	$339.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $205.43 / $309.93 / $491.00	Professional	TC	$205.43	$309.93	$491.00