Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $108.39 / $108.39 / $108.39	Facility	26	$108.39	$108.39	$108.39
Aetna Facility/Professional Professional Modifier Low / Median / High Price $300.52 / $600.99 / $866.94	Professional		$300.52	$600.99	$866.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.39 / $54.19 / $119.38	Professional	26	$30.39	$54.19	$119.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $270.12 / $316.08 / $747.56	Professional	TC	$270.12	$316.08	$747.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $968.37 / $968.37 / $995.48	Professional		$968.37	$968.37	$995.48
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $115.91 / $115.91 / $128.16	Professional	26	$115.91	$115.91	$128.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $840.21 / $840.21 / $879.56	Professional	TC	$840.21	$840.21	$879.56
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $452.20 / $844.23 / $1,522.50	Professional		$452.20	$844.23	$1,522.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.30 / $99.96 / $107.29	Professional	26	$83.30	$99.96	$107.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $620.25 / $744.30 / $798.88	Professional	TC	$620.25	$744.30	$798.88
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,087.50 / $1,201.50 / $1,592.10	Professional		$1,087.50	$1,201.50	$1,592.10
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $128.75 / $139.05 / $188.49	Professional	26	$128.75	$139.05	$188.49
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $958.75 / $1,062.45 / $1,403.61	Professional	TC	$958.75	$1,062.45	$1,403.61
Providence Facility/Professional Professional Modifier Low / Median / High Price $452.20 / $1,190.00 / $2,218.73	Professional		$452.20	$1,190.00	$2,218.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $123.60 / $154.50 / $237.64	Professional	26	$123.60	$154.50	$237.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $879.56 / $1,252.50 / $1,981.10	Professional	TC	$879.56	$1,252.50	$1,981.10
United Facility/Professional Professional Modifier Low / Median / High Price $512.03 / $798.96 / $1,162.05	Professional		$512.03	$798.96	$1,162.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.65 / $102.54 / $153.81	Professional	26	$54.65	$102.54	$153.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $457.38 / $672.16 / $1,008.24	Professional	TC	$457.38	$672.16	$1,008.24