Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $179.94 / $179.94 / $179.94	Facility	26	$179.94	$179.94	$179.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $333.40 / $393.43 / $779.90	Professional		$333.40	$393.43	$779.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.78 / $88.26 / $256.04	Professional	26	$52.78	$88.26	$256.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.14 / $337.38 / $523.86	Professional	TC	$245.14	$337.38	$523.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $297.27 / $700.87 / $864.80	Professional		$297.27	$700.87	$864.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.85 / $186.67 / $213.07	Professional	26	$85.85	$186.67	$213.07
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $211.42 / $487.80 / $678.12	Professional	TC	$211.42	$487.80	$678.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $479.73 / $576.41 / $1,255.05	Professional		$479.73	$576.41	$1,255.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $137.47 / $169.18 / $417.73	Professional	26	$137.47	$169.18	$417.73
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $318.07 / $411.45 / $837.32	Professional	TC	$318.07	$411.45	$837.32
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $742.50 / $962.50 / $1,466.16	Professional		$742.50	$962.50	$1,466.16
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $212.50 / $229.50 / $384.42	Professional	26	$212.50	$229.50	$384.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $530.00 / $746.25 / $1,081.74	Professional	TC	$530.00	$746.25	$1,081.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $278.38 / $760.42 / $1,466.16	Professional		$278.38	$760.42	$1,466.16
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $186.67 / $258.00 / $384.42	Professional	26	$186.67	$258.00	$384.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $538.75 / $746.25 / $1,206.00	Professional	TC	$538.75	$746.25	$1,206.00
United Facility/Professional Professional Modifier Low / Median / High Price $522.35 / $841.05 / $2,254.00	Professional		$522.35	$841.05	$2,254.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.99 / $255.69 / $587.00	Professional	26	$82.99	$255.69	$587.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $390.23 / $390.24 / $1,667.00	Professional	TC	$390.23	$390.24	$1,667.00