Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $218.33 / $218.33 / $1,022.03	Facility	26	$218.33	$218.33	$1,022.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.21 / $179.34 / $570.19	Professional		$147.21	$179.34	$570.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.60 / $106.31 / $899.17	Professional	26	$49.60	$106.31	$899.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.59 / $121.53 / $259.52	Professional	TC	$97.59	$121.53	$259.52
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.80 / $359.32 / $500.87	Professional		$190.80	$359.32	$500.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.95 / $175.39 / $259.82	Professional	26	$104.95	$175.39	$259.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.86 / $183.94 / $262.42	Professional	TC	$85.86	$183.94	$262.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $305.68 / $397.38 / $1,082.77	Professional		$305.68	$397.38	$1,082.77
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $166.58 / $227.73 / $596.04	Professional	26	$166.58	$227.73	$596.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $131.96 / $166.92 / $486.72	Professional	TC	$131.96	$166.92	$486.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $472.50 / $637.50 / $911.74	Professional		$472.50	$637.50	$911.74
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $257.50 / $310.50 / $469.35	Professional	26	$257.50	$310.50	$469.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $215.00 / $301.00 / $475.00	Professional	TC	$215.00	$301.00	$475.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $203.22 / $521.25 / $840.14	Professional		$203.22	$521.25	$840.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $249.60 / $315.00 / $469.35	Professional	26	$249.60	$315.00	$469.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $259.20 / $351.50 / $482.76	Professional	TC	$259.20	$351.50	$482.76
United Facility/Professional Professional Modifier Low / Median / High Price $364.29 / $509.47 / $1,513.00	Professional		$364.29	$509.47	$1,513.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.00 / $259.83 / $777.00	Professional	26	$78.00	$259.83	$777.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.95 / $247.81 / $736.00	Professional	TC	$173.95	$247.81	$736.00