Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $115.86 / $115.86 / $115.86	Facility	26	$115.86	$115.86	$115.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $251.87 / $311.04 / $882.61	Professional		$251.87	$311.04	$882.61
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.17 / $38.67 / $127.60	Professional	26	$33.17	$38.67	$127.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.71 / $272.37 / $755.02	Professional	TC	$218.71	$272.37	$755.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $766.58 / $766.58 / $984.22	Professional		$766.58	$766.58	$984.22
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.53 / $120.53 / $136.94	Professional	26	$120.53	$120.53	$136.94
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $646.05 / $646.05 / $847.27	Professional	TC	$646.05	$646.05	$847.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $458.38 / $861.72 / $1,554.00	Professional		$458.38	$861.72	$1,554.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.95 / $106.74 / $114.57	Professional	26	$88.95	$106.74	$114.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $629.15 / $754.98 / $810.35	Professional	TC	$629.15	$754.98	$810.35
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,110.00 / $1,223.09 / $1,625.04	Professional		$1,110.00	$1,223.09	$1,625.04
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $137.50 / $147.15 / $201.30	Professional	26	$137.50	$147.15	$201.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $972.50 / $1,075.95 / $1,423.74	Professional	TC	$972.50	$1,075.95	$1,423.74
Providence Facility/Professional Professional Modifier Low / Median / High Price $458.38 / $1,206.25 / $2,250.73	Professional		$458.38	$1,206.25	$2,250.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $132.00 / $165.00 / $251.35	Professional	26	$132.00	$165.00	$251.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $847.27 / $1,263.00 / $1,999.38	Professional	TC	$847.27	$1,263.00	$1,999.38
United Facility/Professional Professional Modifier Low / Median / High Price $356.56 / $787.38 / $1,181.07	Professional		$356.56	$787.38	$1,181.07
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.54 / $109.08 / $164.34	Professional	26	$52.54	$109.08	$164.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $304.02 / $677.82 / $1,016.73	Professional	TC	$304.02	$677.82	$1,016.73