Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $464.63 / $493.33 / $894.95	Facility	26	$464.63	$493.33	$894.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $269.14 / $522.50 / $1,333.00	Professional		$269.14	$522.50	$1,333.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.22 / $154.00 / $430.79	Professional	26	$99.22	$154.00	$430.79
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $446.89 / $560.69 / $560.69	Professional	52	$446.89	$560.69	$560.69
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 $310.54 / $692.84 / $752.40	Professional		$310.54	$692.84	$752.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $96.65 / $209.71 / $237.73	Professional	26	$96.65	$209.71	$237.73
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.89 / $455.11 / $537.16	Professional	TC	$213.89	$455.11	$537.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $500.55 / $600.66 / $1,549.02	Professional		$500.55	$600.66	$1,549.02
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 $320.74 / $415.32 / $843.15	Professional	TC	$320.74	$415.32	$843.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $773.75 / $869.70 / $1,439.34	Professional		$773.75	$869.70	$1,439.34
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 $535.00 / $617.50 / $1,032.33	Professional	TC	$535.00	$617.50	$1,032.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $290.70 / $781.25 / $1,413.30	Professional		$290.70	$781.25	$1,413.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $209.71 / $288.00 / $429.12	Professional	26	$209.71	$288.00	$429.12
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 $542.16 / $831.39 / $1,149.45	Professional		$542.16	$831.39	$1,149.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $91.89 / $285.27 / $404.13	Professional	26	$91.89	$285.27	$404.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $364.08 / $549.25 / $773.67	Professional	TC	$364.08	$549.25	$773.67