Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $202.17 / $495.41 / $594.37	Facility	26	$202.17	$495.41	$594.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $347.02 / $522.50 / $1,123.03	Professional		$347.02	$522.50	$1,123.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $154.00 / $396.33	Professional	26	$140.00	$154.00	$396.33
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $238.66 / $238.66 / $238.66	Professional	50	$238.66	$238.66	$238.66
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $447.60 / $561.52 / $561.52	Professional	52	$447.60	$561.52	$561.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $368.50 / $726.70	Professional	TC	$335.00	$368.50	$726.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $311.04 / $753.60 / $900.00	Professional		$311.04	$753.60	$900.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.65 / $222.74 / $270.00	Professional	26	$96.65	$222.74	$270.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $214.39 / $530.86 / $630.00	Professional	TC	$214.39	$530.86	$630.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $501.38 / $601.65 / $1,471.00	Professional		$501.38	$601.65	$1,471.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $154.44 / $189.29 / $467.56	Professional	26	$154.44	$189.29	$467.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $321.49 / $416.31 / $845.13	Professional	TC	$321.49	$416.31	$845.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $775.00 / $871.00 / $1,446.05	Professional		$775.00	$871.00	$1,446.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $238.75 / $257.85 / $436.50	Professional	26	$238.75	$257.85	$436.50
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $536.25 / $617.50 / $1,034.75	Professional	TC	$536.25	$617.50	$1,034.75
Providence Facility/Professional Professional Modifier Low / Median / High Price $291.14 / $782.50 / $1,413.30	Professional		$291.14	$782.50	$1,413.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $209.71 / $292.50 / $435.83	Professional	26	$209.71	$292.50	$435.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $526.79 / $678.00 / $1,010.22	Professional	TC	$526.79	$678.00	$1,010.22
United Facility/Professional Professional Modifier Low / Median / High Price $556.02 / $834.03 / $1,181.54	Professional		$556.02	$834.03	$1,181.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.89 / $287.91 / $407.87	Professional	26	$91.89	$287.91	$407.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $364.08 / $549.25 / $773.67	Professional	TC	$364.08	$549.25	$773.67