Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $152.72 / $152.72 / $166.74	Facility	26	$152.72	$152.72	$166.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $351.88 / $489.69 / $748.49	Professional		$351.88	$489.69	$748.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.67 / $59.49 / $136.36	Professional	26	$56.67	$59.49	$136.36
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $175.94 / $244.85 / $374.25	Professional	52	$175.94	$244.85	$374.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $295.22 / $430.20 / $612.13	Professional	TC	$295.22	$430.20	$612.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $891.98 / $952.72 / $1,197.33	Professional		$891.98	$952.72	$1,197.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $144.01 / $161.19 / $218.58	Professional	26	$144.01	$161.19	$218.58
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $730.78 / $808.71 / $978.77	Professional	TC	$730.78	$808.71	$978.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $965.57 / $1,205.22 / $1,571.85	Professional		$965.57	$1,205.22	$1,571.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $139.90 / $167.88 / $270.24	Professional	26	$139.90	$167.88	$270.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $799.56 / $1,037.33 / $1,301.61	Professional	TC	$799.56	$1,037.33	$1,301.61
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $562.11 / $1,552.50 / $2,164.80	Professional		$562.11	$1,552.50	$2,164.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $87.50 / $216.25 / $283.20	Professional	26	$87.50	$216.25	$283.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $482.59 / $1,336.25 / $1,844.70	Professional	TC	$482.59	$1,336.25	$1,844.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $534.66 / $1,007.22 / $2,064.98	Professional		$534.66	$1,007.22	$2,064.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $111.13 / $217.50 / $345.15	Professional	26	$111.13	$217.50	$345.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $572.50 / $1,320.00 / $2,199.60	Professional	TC	$572.50	$1,320.00	$2,199.60
United Facility/Professional Professional Modifier Low / Median / High Price $957.88 / $992.38 / $1,915.76	Professional		$957.88	$992.38	$1,915.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $148.63 / $174.86 / $349.72	Professional	26	$148.63	$174.86	$349.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $783.02 / $843.75 / $1,690.42	Professional	TC	$783.02	$843.75	$1,690.42