Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $359.48 / $359.48 / $359.48	Facility	26	$359.48	$359.48	$359.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $182.65 / $219.21 / $493.18	Professional		$182.65	$219.21	$493.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.75 / $132.38 / $293.95	Professional	26	$105.75	$132.38	$293.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.90 / $92.39 / $154.40	Professional	TC	$76.90	$92.39	$154.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $472.04 / $549.57 / $736.69	Professional		$472.04	$549.57	$736.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $301.67 / $346.08 / $466.77	Professional	26	$301.67	$346.08	$466.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $170.37 / $203.50 / $269.92	Professional	TC	$170.37	$203.50	$269.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $503.80 / $604.55 / $874.93	Professional		$503.80	$604.55	$874.93
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $312.14 / $374.58 / $585.45	Professional	26	$312.14	$374.58	$585.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $229.98 / $289.49	Professional	TC	$177.83	$229.98	$289.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $320.00 / $808.80 / $1,140.08	Professional		$320.00	$808.80	$1,140.08
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $176.40 / $482.50 / $706.38	Professional	26	$176.40	$482.50	$706.38
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $130.94 / $319.95 / $441.60	Professional	TC	$130.94	$319.95	$441.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $268.08 / $539.20 / $1,170.63	Professional		$268.08	$539.20	$1,170.63
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $193.00 / $482.50 / $842.60	Professional	26	$193.00	$482.50	$842.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $139.50 / $308.75 / $640.20	Professional	TC	$139.50	$308.75	$640.20
United Facility/Professional Professional Modifier Low / Median / High Price $541.29 / $589.36 / $1,839.26	Professional		$541.29	$589.36	$1,839.26
United Facility/Professional Professional Modifier 26 Low / Median / High Price $329.08 / $373.42 / $1,131.19	Professional	26	$329.08	$373.42	$1,131.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $212.21 / $215.94 / $708.07	Professional	TC	$212.21	$215.94	$708.07