Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $155.79 / $155.79 / $155.79	Facility	26	$155.79	$155.79	$155.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.82 / $586.62 / $895.83	Professional		$293.82	$586.62	$895.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.47 / $84.29 / $171.56	Professional	26	$43.47	$84.29	$171.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $250.34 / $292.95 / $724.26	Professional	TC	$250.34	$292.95	$724.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $995.06 / $995.06 / $1,012.47	Professional		$995.06	$995.06	$1,012.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $166.87 / $166.87 / $185.11	Professional	26	$166.87	$166.87	$185.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $809.95 / $809.95 / $845.60	Professional	TC	$809.95	$809.95	$845.60
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $457.90 / $862.68 / $1,555.75	Professional		$457.90	$862.68	$1,555.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $118.88 / $142.65 / $153.11	Professional	26	$118.88	$142.65	$153.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $600.03 / $720.03 / $772.83	Professional	TC	$600.03	$720.03	$772.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,111.25 / $1,228.50 / $1,626.87	Professional		$1,111.25	$1,228.50	$1,626.87
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $183.75 / $198.45 / $269.01	Professional	26	$183.75	$198.45	$269.01
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $927.50 / $1,030.05 / $1,357.86	Professional	TC	$927.50	$1,030.05	$1,357.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $457.90 / $1,205.00 / $2,239.30	Professional		$457.90	$1,205.00	$2,239.30
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $176.40 / $223.50 / $342.75	Professional	26	$176.40	$223.50	$342.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $845.60 / $1,207.50 / $1,896.55	Professional	TC	$845.60	$1,207.50	$1,896.55
United Facility/Professional Professional Modifier Low / Median / High Price $501.94 / $796.04 / $1,194.06	Professional		$501.94	$796.04	$1,194.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $78.00 / $148.38 / $222.15	Professional	26	$78.00	$148.38	$222.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $423.94 / $647.94 / $971.91	Professional	TC	$423.94	$647.94	$971.91