Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.85 / $123.85 / $123.85	Facility	26	$123.85	$123.85	$123.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $138.69 / $332.62 / $462.50	Professional		$138.69	$332.62	$462.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.62 / $196.21 / $302.00	Professional	TC	$100.62	$196.21	$302.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $162.59 / $222.75 / $389.40	Professional		$162.59	$222.75	$389.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.24 / $175.10 / $253.97	Professional	TC	$102.24	$175.10	$253.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $262.00 / $314.39 / $694.82	Professional		$262.00	$314.39	$694.82
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $157.34 / $198.93 / $406.01	Professional	TC	$157.34	$198.93	$406.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $343.75 / $441.45 / $648.15	Professional		$343.75	$441.45	$648.15
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $198.75 / $282.14 / $388.89	Professional	TC	$198.75	$282.14	$388.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $154.12 / $348.80 / $594.10	Professional		$154.12	$348.80	$594.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $198.75 / $261.25 / $375.87	Professional	TC	$198.75	$261.25	$375.87
United Facility/Professional Professional Modifier Low / Median / High Price $234.52 / $296.64 / $633.11	Professional		$234.52	$296.64	$633.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.07 / $179.34 / $315.43	Professional	TC	$140.07	$179.34	$315.43