Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $148.22 / $204.07 / $455.06	Facility	26	$148.22	$204.07	$455.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.55 / $386.96 / $572.03	Professional		$130.55	$386.96	$572.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.60 / $57.40 / $192.58	Professional	26	$42.60	$57.40	$192.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $114.59 / $309.95	Professional	TC	$87.95	$114.59	$309.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.49 / $224.29 / $430.09	Professional		$144.49	$224.29	$430.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.68 / $91.02 / $174.29	Professional	26	$52.68	$91.02	$174.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.81 / $133.27 / $255.80	Professional	TC	$91.81	$133.27	$255.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $325.08 / $390.09 / $791.23	Professional		$325.08	$390.09	$791.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.03 / $136.83 / $315.63	Professional	26	$114.03	$136.83	$315.63
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $209.19 / $253.26 / $475.66	Professional	TC	$209.19	$253.26	$475.66
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $496.25 / $582.90 / $812.00	Professional		$496.25	$582.90	$812.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $176.25 / $204.45 / $288.00	Professional	26	$176.25	$204.45	$288.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $317.50 / $378.45 / $524.00	Professional	TC	$317.50	$378.45	$524.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $174.06 / $430.09 / $790.00	Professional		$174.06	$430.09	$790.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $103.66 / $211.50 / $317.80	Professional	26	$103.66	$211.50	$317.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $235.69 / $381.00 / $598.66	Professional	TC	$235.69	$381.00	$598.66
United Facility/Professional Professional Modifier Low / Median / High Price $191.15 / $430.08 / $717.40	Professional		$191.15	$430.08	$717.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.27 / $174.28 / $290.70	Professional	26	$65.27	$174.28	$290.70
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.91 / $255.80 / $426.69	Professional	TC	$114.91	$255.80	$426.69