Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $155.05 / $155.05 / $155.05	Facility	26	$155.05	$155.05	$155.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $275.05 / $334.46 / $738.74	Professional		$275.05	$334.46	$738.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.65 / $57.46 / $126.79	Professional	26	$45.65	$57.46	$126.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $229.40 / $281.52 / $611.95	Professional	TC	$229.40	$281.52	$611.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $793.99 / $845.59 / $1,072.89	Professional		$793.99	$845.59	$1,072.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $130.72 / $148.72 / $200.59	Professional	26	$130.72	$148.72	$200.59
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $663.25 / $696.87 / $872.30	Professional	TC	$663.25	$696.87	$872.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $902.31 / $1,127.60 / $1,468.88	Professional		$902.31	$1,127.60	$1,468.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $134.25 / $161.10 / $252.18	Professional	26	$134.25	$161.10	$252.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $747.40 / $966.51 / $1,216.71	Professional	TC	$747.40	$966.51	$1,216.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $541.54 / $1,452.50 / $1,962.27	Professional		$541.54	$1,452.50	$1,962.27
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.31 / $207.50 / $303.77	Professional	26	$76.31	$207.50	$303.77
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $465.23 / $1,177.50 / $1,668.28	Professional	TC	$465.23	$1,177.50	$1,668.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $487.83 / $975.65 / $1,716.00	Professional		$487.83	$975.65	$1,716.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.00 / $206.64 / $377.03	Professional	26	$83.00	$206.64	$377.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $484.00 / $1,079.82 / $1,887.60	Professional	TC	$484.00	$1,079.82	$1,887.60
United Facility/Professional Professional Modifier Low / Median / High Price $857.90 / $858.32 / $1,716.64	Professional		$857.90	$858.32	$1,716.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $141.76 / $160.47 / $280.83	Professional	26	$141.76	$160.47	$280.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $697.84 / $841.16 / $1,506.54	Professional	TC	$697.84	$841.16	$1,506.54