Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $146.47 / $146.47 / $159.91	Facility	26	$146.47	$146.47	$159.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $380.98 / $451.62 / $805.25	Professional		$380.98	$451.62	$805.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.34 / $63.17 / $130.78	Professional	26	$54.34	$63.17	$130.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $326.64 / $386.31 / $674.47	Professional	TC	$326.64	$386.31	$674.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $822.20 / $937.72 / $1,216.78	Professional		$822.20	$937.72	$1,216.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $135.91 / $153.58 / $208.76	Professional	26	$135.91	$153.58	$208.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $686.28 / $784.15 / $1,008.02	Professional	TC	$686.28	$784.15	$1,008.02
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,018.52 / $1,277.04 / $1,658.06	Professional		$1,018.52	$1,277.04	$1,658.06
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $135.85 / $163.02 / $260.30	Professional	26	$135.85	$163.02	$260.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $858.62 / $1,114.02 / $1,397.76	Professional	TC	$858.62	$1,114.02	$1,397.76
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $592.27 / $1,645.00 / $2,386.80	Professional		$592.27	$1,645.00	$2,386.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $84.00 / $210.00 / $297.52	Professional	26	$84.00	$210.00	$297.52
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $515.50 / $1,435.00 / $1,880.80	Professional	TC	$515.50	$1,435.00	$1,880.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $550.79 / $1,085.40 / $2,178.33	Professional		$550.79	$1,085.40	$2,178.33
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $84.00 / $210.00 / $383.88	Professional	26	$84.00	$210.00	$383.88
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $533.00 / $1,298.40 / $2,412.96	Professional	TC	$533.00	$1,298.40	$2,412.96
United Facility/Professional Professional Modifier Low / Median / High Price $973.42 / $1,073.13 / $1,946.84	Professional		$973.42	$1,073.13	$1,946.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $143.47 / $167.00 / $334.00	Professional	26	$143.47	$167.00	$334.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $806.42 / $847.22 / $1,612.84	Professional	TC	$806.42	$847.22	$1,612.84