Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $430.91 / $430.91 / $430.91	Facility	26	$430.91	$430.91	$430.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.18 / $256.52 / $525.89	Professional		$203.18	$256.52	$525.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $125.75 / $158.68 / $352.36	Professional	26	$125.75	$158.68	$352.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.43 / $104.53 / $173.53	Professional	TC	$77.43	$104.53	$173.53
Cigna Facility/Professional Professional Modifier Low / Median / High Price $554.50 / $637.98 / $847.50	Professional		$554.50	$637.98	$847.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $361.74 / $414.07 / $556.80	Professional	26	$361.74	$414.07	$556.80
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $192.76 / $223.92 / $290.69	Professional	TC	$192.76	$223.92	$290.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $587.10 / $704.52 / $1,022.49	Professional		$587.10	$704.52	$1,022.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $373.60 / $448.32 / $700.53	Professional	26	$373.60	$448.32	$700.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $197.80 / $256.17 / $322.00	Professional	TC	$197.80	$256.17	$322.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $338.18 / $907.50 / $1,181.57	Professional		$338.18	$907.50	$1,181.57
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $210.68 / $570.78 / $818.20	Professional	26	$210.68	$570.78	$818.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $131.85 / $351.60 / $452.80	Professional	TC	$131.85	$351.60	$452.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $312.94 / $626.04 / $1,176.00	Professional		$312.94	$626.04	$1,176.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $230.00 / $550.79 / $897.00	Professional	26	$230.00	$550.79	$897.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $142.50 / $348.75 / $571.35	Professional	TC	$142.50	$348.75	$571.35
United Facility/Professional Professional Modifier Low / Median / High Price $633.23 / $678.00 / $1,356.00	Professional		$633.23	$678.00	$1,356.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $394.37 / $445.46 / $961.68	Professional	26	$394.37	$445.46	$961.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $232.54 / $235.34 / $465.08	Professional	TC	$232.54	$235.34	$465.08