Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $162.43 / $162.43 / $162.43	Facility	26	$162.43	$162.43	$162.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $171.32 / $330.15 / $403.75	Professional		$171.32	$330.15	$403.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.07 / $132.83 / $162.43	Professional	26	$59.07	$132.83	$162.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.26 / $197.32 / $241.32	Professional	TC	$112.26	$197.32	$241.32
Cigna Facility/Professional Professional Modifier Low / Median / High Price $308.55 / $438.76 / $923.77	Professional		$308.55	$438.76	$923.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.67 / $87.39 / $208.83	Professional	26	$58.67	$87.39	$208.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $249.88 / $351.37 / $714.94	Professional	TC	$249.88	$351.37	$714.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $508.47 / $851.04 / $1,203.08	Professional		$508.47	$851.04	$1,203.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.90 / $167.88 / $385.87	Professional	26	$139.90	$167.88	$385.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $569.29 / $683.16 / $1,441.07	Professional	TC	$569.29	$683.16	$1,441.07
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $986.04 / $1,325.70 / $1,604.91	Professional		$986.04	$1,325.70	$1,604.91
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $183.70 / $234.90 / $316.58	Professional	26	$183.70	$234.90	$316.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $801.36 / $1,090.80 / $1,298.50	Professional	TC	$801.36	$1,090.80	$1,298.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $364.79 / $923.77 / $1,597.75	Professional		$364.79	$923.77	$1,597.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $108.67 / $252.30 / $329.00	Professional	26	$108.67	$252.30	$329.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $400.50 / $1,065.00 / $1,400.40	Professional	TC	$400.50	$1,065.00	$1,400.40
United Facility/Professional Professional Modifier Low / Median / High Price $395.83 / $762.74 / $1,478.04	Professional		$395.83	$762.74	$1,478.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $79.00 / $167.06 / $334.12	Professional	26	$79.00	$167.06	$334.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $318.36 / $596.16 / $1,143.92	Professional	TC	$318.36	$596.16	$1,143.92