Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $295.12 / $295.12 / $295.12	Facility	26	$295.12	$295.12	$295.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $199.53 / $371.54	Professional		$169.82	$199.53	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $107.15 / $190.55	Professional	26	$93.33	$107.15	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $81.28 / $123.03	Professional	TC	$70.79	$81.28	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $457.09 / $616.60	Professional		$389.05	$457.09	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $275.42 / $380.19	Professional	26	$239.88	$275.42	$380.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $177.83 / $234.42	Professional	TC	$147.91	$177.83	$234.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $489.78 / $1,174.90	Professional		$177.83	$489.78	$1,174.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $309.03 / $524.81	Professional	26	$107.15	$309.03	$524.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $194.98 / $316.23	Professional	TC	$79.43	$194.98	$316.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $380.19 / $707.95 / $954.99	Professional		$380.19	$707.95	$954.99
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $204.17 / $416.87 / $549.54	Professional	26	$204.17	$416.87	$549.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $288.40 / $380.19	Professional	TC	$169.82	$288.40	$380.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $436.52 / $562.34	Professional		$199.53	$436.52	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $186.21 / $380.19	Professional	26	$102.33	$186.21	$380.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $131.83 / $234.42	Professional	TC	$81.28	$131.83	$234.42
United Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $489.78 / $1,047.13	Professional		$239.88	$489.78	$1,047.13
United Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $302.00 / $645.65	Professional	26	$147.91	$302.00	$645.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $190.55 / $407.38	Professional	TC	$95.50	$190.55	$407.38