Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $163.55 / $163.55 / $163.55	Facility	26	$163.55	$163.55	$163.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.19 / $623.79 / $623.79	Professional		$216.19	$623.79	$623.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.21 / $180.13 / $180.13	Professional	26	$49.21	$180.13	$180.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $166.97 / $443.67 / $443.67	Professional	TC	$166.97	$443.67	$443.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $303.81 / $759.89 / $1,125.00	Professional		$303.81	$759.89	$1,125.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.50 / $170.13 / $195.23	Professional	26	$78.50	$170.13	$195.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $225.32 / $431.03 / $580.32	Professional	TC	$225.32	$431.03	$580.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $486.01 / $589.02 / $1,282.99	Professional		$486.01	$589.02	$1,282.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.35 / $153.72 / $379.50	Professional	26	$125.35	$153.72	$379.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $339.12 / $438.63 / $903.49	Professional	TC	$339.12	$438.63	$903.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $758.75 / $865.80 / $1,461.69	Professional		$758.75	$865.80	$1,461.69
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $193.75 / $209.25 / $353.13	Professional	26	$193.75	$209.25	$353.13
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $565.00 / $660.40 / $1,108.56	Professional	TC	$565.00	$660.40	$1,108.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $284.57 / $775.00 / $1,398.60	Professional		$284.57	$775.00	$1,398.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $170.13 / $237.00 / $353.13	Professional	26	$170.13	$237.00	$353.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $508.00 / $744.00 / $1,108.56	Professional	TC	$508.00	$744.00	$1,108.56
United Facility/Professional Professional Modifier Low / Median / High Price $367.46 / $834.15 / $2,662.00	Professional		$367.46	$834.15	$2,662.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $83.84 / $233.46 / $735.00	Professional	26	$83.84	$233.46	$735.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $288.63 / $599.88 / $1,927.00	Professional	TC	$288.63	$599.88	$1,927.00