Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $234.44 / $234.44 / $234.44	Facility	26	$234.44	$234.44	$234.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $307.26 / $402.57 / $836.84	Professional		$307.26	$402.57	$836.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.36 / $87.78 / $191.70	Professional	26	$68.36	$87.78	$191.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $238.90 / $313.13 / $645.14	Professional	TC	$238.90	$313.13	$645.14
Cigna Facility/Professional Professional Modifier Low / Median / High Price $960.47 / $1,004.14 / $1,215.86	Professional		$960.47	$1,004.14	$1,215.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $207.83 / $225.80 / $304.05	Professional	26	$207.83	$225.80	$304.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $734.67 / $796.31 / $911.82	Professional	TC	$734.67	$796.31	$911.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,043.22 / $1,289.67 / $1,698.27	Professional		$1,043.22	$1,289.67	$1,698.27
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $202.98 / $243.57 / $381.19	Professional	26	$202.98	$243.57	$381.19
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $809.07 / $1,046.09 / $1,317.09	Professional	TC	$809.07	$1,046.09	$1,317.09
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $589.00 / $1,557.50 / $2,206.67	Professional		$589.00	$1,557.50	$2,206.67
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $115.16 / $313.75 / $448.06	Professional	26	$115.16	$313.75	$448.06
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $492.65 / $1,347.50 / $1,758.60	Professional	TC	$492.65	$1,347.50	$1,758.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $542.45 / $1,084.90 / $1,923.00	Professional		$542.45	$1,084.90	$1,923.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $131.00 / $310.00 / $493.35	Professional	26	$131.00	$310.00	$493.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $574.50 / $1,149.00 / $1,987.05	Professional	TC	$574.50	$1,149.00	$1,987.05
United Facility/Professional Professional Modifier Low / Median / High Price $967.08 / $1,101.48 / $1,945.40	Professional		$967.08	$1,101.48	$1,945.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $214.81 / $243.24 / $525.12	Professional	26	$214.81	$243.24	$525.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $729.46 / $729.46 / $1,458.92	Professional	TC	$729.46	$729.46	$1,458.92