Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $695.80 / $695.80 / $695.80	Facility		$695.80	$695.80	$695.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.94 / $402.78 / $402.78	Professional		$177.94	$402.78	$402.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.97 / $157.35 / $659.88	Professional	26	$46.97	$157.35	$659.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.44 / $245.44 / $245.44	Professional	TC	$108.44	$245.44	$245.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.73 / $102.73 / $102.73	Professional		$102.73	$102.73	$102.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.26 / $57.26 / $57.26	Professional	26	$57.26	$57.26	$57.26
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $45.47 / $45.47 / $45.47	Professional	TC	$45.47	$45.47	$45.47
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $48.93 / $478.21 / $589.75	Professional		$48.93	$478.21	$589.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.98 / $95.98 / $95.98	Professional	26	$95.98	$95.98	$95.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.07 / $177.07 / $177.07	Professional	TC	$177.07	$177.07	$177.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $132.96 / $421.25 / $616.71	Professional		$132.96	$421.25	$616.71
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $70.25 / $126.25 / $184.83	Professional	26	$70.25	$126.25	$184.83
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $62.71 / $295.00 / $431.88	Professional	TC	$62.71	$295.00	$431.88
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.73 / $397.50 / $573.50	Professional		$102.73	$397.50	$573.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.26 / $126.25 / $192.40	Professional	26	$57.26	$126.25	$192.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.47 / $271.25 / $381.10	Professional	TC	$45.47	$271.25	$381.10
United Facility/Professional Professional Modifier Low / Median / High Price $180.95 / $258.30 / $387.45	Professional		$180.95	$258.30	$387.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.91 / $151.91 / $151.91	Professional	26	$151.91	$151.91	$151.91
United Facility/Professional Professional Modifier TC Low / Median / High Price $126.72 / $126.72 / $235.53	Professional	TC	$126.72	$126.72	$235.53