Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $200.85 / $200.85 / $200.85	Facility	26	$200.85	$200.85	$200.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $308.87 / $379.91 / $924.04	Professional		$308.87	$379.91	$924.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.15 / $66.45 / $221.21	Professional	26	$57.15	$66.45	$221.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.71 / $313.45 / $702.83	Professional	TC	$251.71	$313.45	$702.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $944.18 / $944.18 / $1,014.82	Professional		$944.18	$944.18	$1,014.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $208.97 / $208.97 / $237.15	Professional	26	$208.97	$208.97	$237.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $735.21 / $735.21 / $777.67	Professional	TC	$735.21	$735.21	$777.67
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $464.08 / $890.82 / $1,606.50	Professional		$464.08	$890.82	$1,606.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $152.83 / $183.39 / $196.84	Professional	26	$152.83	$183.39	$196.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $589.53 / $707.43 / $759.31	Professional	TC	$589.53	$707.43	$759.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,147.50 / $1,267.65 / $1,679.94	Professional		$1,147.50	$1,267.65	$1,679.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $236.25 / $255.15 / $345.87	Professional	26	$236.25	$255.15	$345.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $911.25 / $1,012.50 / $1,334.07	Professional	TC	$911.25	$1,012.50	$1,334.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $464.08 / $1,221.25 / $2,280.42	Professional		$464.08	$1,221.25	$2,280.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $226.80 / $285.00 / $436.44	Professional	26	$226.80	$285.00	$436.44
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $777.67 / $1,159.50 / $1,844.00	Professional	TC	$777.67	$1,159.50	$1,844.00
United Facility/Professional Professional Modifier Low / Median / High Price $610.72 / $811.86 / $1,217.79	Professional		$610.72	$811.86	$1,217.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $137.96 / $189.72 / $284.58	Professional	26	$137.96	$189.72	$284.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $472.76 / $622.14 / $933.21	Professional	TC	$472.76	$622.14	$933.21