Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $193.21 / $217.47 / $217.47	Facility	26	$193.21	$217.47	$217.47
Aetna Facility/Professional Professional Modifier Low / Median / High Price $229.24 / $282.38 / $462.86	Professional		$229.24	$282.38	$462.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $79.45 / $94.75 / $193.21	Professional	26	$79.45	$94.75	$193.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $148.83 / $187.64 / $269.64	Professional	TC	$148.83	$187.64	$269.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.03 / $375.80 / $597.86	Professional		$223.03	$375.80	$597.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.61 / $101.15 / $252.02	Professional	26	$69.61	$101.15	$252.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $151.46 / $200.96 / $420.31	Professional	TC	$151.46	$200.96	$420.31
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $360.96 / $530.82 / $787.91	Professional		$360.96	$530.82	$787.91
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $163.35 / $196.02 / $458.19	Professional	26	$163.35	$196.02	$458.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $279.00 / $334.80 / $631.15	Professional	TC	$279.00	$334.80	$631.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $663.75 / $750.60 / $1,001.01	Professional		$663.75	$750.60	$1,001.01
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $218.16 / $272.70 / $369.66	Professional	26	$218.16	$272.70	$369.66
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $431.25 / $484.65 / $642.62	Professional	TC	$431.25	$484.65	$642.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $252.23 / $588.10 / $996.96	Professional		$252.23	$588.10	$996.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $129.87 / $301.50 / $388.65	Professional	26	$129.87	$301.50	$388.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $241.20 / $501.00 / $814.93	Professional	TC	$241.20	$501.00	$814.93
United Facility/Professional Professional Modifier Low / Median / High Price $275.38 / $470.48 / $764.53	Professional		$275.38	$470.48	$764.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.74 / $201.62 / $327.63	Professional	26	$108.74	$201.62	$327.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $173.00 / $268.86 / $436.90	Professional	TC	$173.00	$268.86	$436.90