Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $142.85 / $142.85 / $142.85	Facility	26	$142.85	$142.85	$142.85
Aetna Facility/Professional Professional Modifier Low / Median / High Price $228.16 / $280.83 / $623.46	Professional		$228.16	$280.83	$623.46
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.77 / $49.92 / $157.33	Professional	26	$42.77	$49.92	$157.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $185.40 / $230.90 / $466.13	Professional	TC	$185.40	$230.90	$466.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $626.74 / $626.74 / $687.14	Professional		$626.74	$626.74	$687.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $147.96 / $147.96 / $169.91	Professional	26	$147.96	$147.96	$169.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $478.78 / $478.78 / $517.24	Professional	TC	$478.78	$478.78	$517.24
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $313.02 / $600.66 / $1,083.25	Professional		$313.02	$600.66	$1,083.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $109.18 / $131.01 / $140.62	Professional	26	$109.18	$131.01	$140.62
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $391.40 / $469.68 / $504.12	Professional	TC	$391.40	$469.68	$504.12
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $773.75 / $851.85 / $1,132.77	Professional		$773.75	$851.85	$1,132.77
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $168.75 / $182.25 / $247.05	Professional	26	$168.75	$182.25	$247.05
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $605.00 / $669.60 / $885.72	Professional	TC	$605.00	$669.60	$885.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $313.02 / $823.75 / $1,533.24	Professional		$313.02	$823.75	$1,533.24
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $162.00 / $205.50 / $313.05	Professional	26	$162.00	$205.50	$313.05
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $517.24 / $771.00 / $1,220.19	Professional	TC	$517.24	$771.00	$1,220.19
United Facility/Professional Professional Modifier Low / Median / High Price $378.85 / $549.72 / $824.58	Professional		$378.85	$549.72	$824.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $67.39 / $135.74 / $203.88	Professional	26	$67.39	$135.74	$203.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $311.45 / $413.80 / $620.70	Professional	TC	$311.45	$413.80	$620.70