Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $105.29 / $105.29 / $105.29	Facility	26	$105.29	$105.29	$105.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.87 / $287.52 / $382.42	Professional		$193.87	$287.52	$382.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.61 / $48.87 / $86.09	Professional	26	$23.61	$48.87	$86.09
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.96 / $238.66 / $306.48	Professional	TC	$169.96	$238.66	$306.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.89 / $297.54 / $611.11	Professional		$192.89	$297.54	$611.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.73 / $52.28 / $138.85	Professional	26	$26.73	$52.28	$138.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.38 / $247.47 / $472.26	Professional	TC	$154.38	$247.47	$472.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $463.13 / $572.52 / $1,108.32	Professional		$463.13	$572.52	$1,108.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $90.58 / $108.69 / $249.17	Professional	26	$90.58	$108.69	$249.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $386.55 / $463.86 / $859.16	Professional	TC	$386.55	$463.86	$859.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $644.76 / $801.90 / $1,079.70	Professional		$644.76	$801.90	$1,079.70
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 $521.64 / $650.70 / $872.34	Professional	TC	$521.64	$650.70	$872.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $267.73 / $575.26 / $1,044.75	Professional		$267.73	$575.26	$1,044.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.28 / $165.30 / $219.34	Professional	26	$52.28	$165.30	$219.34
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $251.53 / $697.45 / $902.36	Professional	TC	$251.53	$697.45	$902.36
United Facility/Professional Professional Modifier Low / Median / High Price $351.26 / $499.24 / $977.76	Professional		$351.26	$499.24	$977.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.06 / $111.08 / $210.24	Professional	26	$34.06	$111.08	$210.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $319.41 / $387.86 / $755.60	Professional	TC	$319.41	$387.86	$755.60