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 $319.50 / $400.63 / $853.34	Professional		$319.50	$400.63	$853.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.65 / $57.27 / $126.79	Professional	26	$45.65	$57.27	$126.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $273.83 / $347.39 / $726.55	Professional	TC	$273.83	$347.39	$726.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $908.66 / $1,009.40 / $1,266.74	Professional		$908.66	$1,009.40	$1,266.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $130.35 / $149.46 / $201.60	Professional	26	$130.35	$149.46	$201.60
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $778.32 / $859.94 / $1,065.15	Professional	TC	$778.32	$859.94	$1,065.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,045.57 / $1,312.95 / $1,702.09	Professional		$1,045.57	$1,312.95	$1,702.09
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 $890.66 / $1,151.84 / $1,449.91	Professional	TC	$890.66	$1,151.84	$1,449.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $623.80 / $1,661.25 / $2,341.94	Professional		$623.80	$1,661.25	$2,341.94
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.31 / $207.90 / $300.00	Professional	26	$76.31	$207.90	$300.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $547.49 / $1,483.75 / $2,020.20	Professional	TC	$547.49	$1,483.75	$2,020.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $564.60 / $1,132.95 / $1,996.50	Professional		$564.60	$1,132.95	$1,996.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.50 / $207.90 / $325.64	Professional	26	$83.50	$207.90	$325.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $582.00 / $1,303.75 / $2,269.80	Professional	TC	$582.00	$1,303.75	$2,269.80
United Facility/Professional Professional Modifier Low / Median / High Price $992.72 / $1,013.40 / $2,026.80	Professional		$992.72	$1,013.40	$2,026.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $141.76 / $161.28 / $348.18	Professional	26	$141.76	$161.28	$348.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $852.12 / $998.38 / $1,839.60	Professional	TC	$852.12	$998.38	$1,839.60