Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $237.40 / $237.40 / $237.40	Facility	26	$237.40	$237.40	$237.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $522.50 / $690.22	Professional		$475.00	$522.50	$690.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $154.00 / $261.45	Professional	26	$140.00	$154.00	$261.45
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $368.50 / $428.76	Professional	TC	$335.00	$368.50	$428.76
Cigna Facility/Professional Professional Modifier Low / Median / High Price $333.18 / $664.11 / $818.87	Professional		$333.18	$664.11	$818.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $113.82 / $245.82 / $280.82	Professional	26	$113.82	$245.82	$280.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $219.36 / $418.29 / $558.60	Professional	TC	$219.36	$418.29	$558.60
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $537.75 / $645.29 / $1,426.04	Professional		$537.75	$645.29	$1,426.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $181.95 / $223.31 / $549.78	Professional	26	$181.95	$223.31	$549.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $330.11 / $426.96 / $876.26	Professional	TC	$330.11	$426.96	$876.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $831.25 / $937.30 / $1,582.38	Professional		$831.25	$937.30	$1,582.38
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $281.25 / $303.75 / $507.35	Professional	26	$281.25	$303.75	$507.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $550.00 / $640.90 / $1,075.04	Professional	TC	$550.00	$640.90	$1,075.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $316.30 / $843.75 / $1,514.10	Professional		$316.30	$843.75	$1,514.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $245.82 / $340.50 / $507.35	Professional	26	$245.82	$340.50	$507.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $493.00 / $721.50 / $1,075.04	Professional	TC	$493.00	$721.50	$1,075.04
United Facility/Professional Professional Modifier Low / Median / High Price $612.48 / $918.72 / $1,904.22	Professional		$612.48	$918.72	$1,904.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.30 / $304.00 / $465.91	Professional	26	$109.30	$304.00	$465.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $387.82 / $585.07 / $1,560.90	Professional	TC	$387.82	$585.07	$1,560.90