Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.00 / $108.75 / $276.02	Facility	26	$87.00	$108.75	$276.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $201.47 / $278.63 / $657.00	Professional		$201.47	$278.63	$657.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.13 / $48.41 / $153.82	Professional	26	$31.13	$48.41	$153.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.96 / $230.22 / $350.91	Professional	TC	$169.96	$230.22	$350.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.91 / $286.14 / $593.17	Professional		$186.91	$286.14	$593.17
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.13 / $57.87 / $139.08	Professional	26	$35.13	$57.87	$139.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.28 / $237.68 / $454.10	Professional	TC	$148.28	$237.68	$454.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $442.75 / $545.37 / $1,066.21	Professional		$442.75	$545.37	$1,066.21
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.58 / $108.69 / $249.98	Professional	26	$90.58	$108.69	$249.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $363.90 / $436.68 / $816.28	Professional	TC	$363.90	$436.68	$816.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $589.60 / $769.50 / $1,028.46	Professional		$589.60	$769.50	$1,028.46
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.74 / $151.19 / $204.96	Professional	26	$103.74	$151.19	$204.96
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $496.10 / $618.29 / $823.50	Professional	TC	$496.10	$618.29	$823.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $226.33 / $561.54 / $1,021.73	Professional		$226.33	$561.54	$1,021.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $67.80 / $165.30 / $217.41	Professional	26	$67.80	$165.30	$217.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $246.31 / $669.90 / $867.72	Professional	TC	$246.31	$669.90	$867.72
United Facility/Professional Professional Modifier Low / Median / High Price $255.68 / $474.54 / $949.08	Professional		$255.68	$474.54	$949.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $42.51 / $111.26 / $222.52	Professional	26	$42.51	$111.26	$222.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $304.32 / $374.98 / $687.56	Professional	TC	$304.32	$374.98	$687.56