Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $149.16 / $149.16 / $149.16	Facility	26	$149.16	$149.16	$149.16
Aetna Facility/Professional Professional Modifier Low / Median / High Price $267.32 / $329.43 / $931.41	Professional		$267.32	$329.43	$931.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $50.69 / $164.28	Professional	26	$43.47	$50.69	$164.28
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $223.84 / $278.72 / $767.13	Professional	TC	$223.84	$278.72	$767.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $927.53 / $927.53 / $1,030.66	Professional		$927.53	$927.53	$1,030.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $154.11 / $154.11 / $177.34	Professional	26	$154.11	$154.11	$177.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $773.42 / $773.42 / $853.32	Professional	TC	$773.42	$773.42	$853.32
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $474.05 / $902.46 / $1,627.50	Professional		$474.05	$902.46	$1,627.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $114.03 / $136.83 / $146.86	Professional	26	$114.03	$136.83	$146.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $638.03 / $765.63 / $821.78	Professional	TC	$638.03	$765.63	$821.78
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,162.50 / $1,282.50 / $1,701.90	Professional		$1,162.50	$1,282.50	$1,701.90
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $176.25 / $190.35 / $258.02	Professional	26	$176.25	$190.35	$258.02
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $986.25 / $1,092.15 / $1,443.87	Professional	TC	$986.25	$1,092.15	$1,443.87
Providence Facility/Professional Professional Modifier Low / Median / High Price $474.05 / $1,247.50 / $2,319.28	Professional		$474.05	$1,247.50	$2,319.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $169.20 / $214.50 / $324.47	Professional	26	$169.20	$214.50	$324.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $853.32 / $1,272.00 / $1,994.81	Professional	TC	$853.32	$1,272.00	$1,994.81
United Facility/Professional Professional Modifier Low / Median / High Price $427.13 / $824.52 / $1,236.78	Professional		$427.13	$824.52	$1,236.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.44 / $140.86 / $212.82	Professional	26	$68.44	$140.86	$212.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $358.69 / $682.64 / $1,023.96	Professional	TC	$358.69	$682.64	$1,023.96