Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $123.66 / $123.66 / $123.66	Facility	26	$123.66	$123.66	$123.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $260.66 / $327.39 / $698.66	Professional		$260.66	$327.39	$698.66
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $130.33 / $169.28 / $349.33	Professional	52	$130.33	$169.28	$349.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $224.12 / $281.30 / $597.54	Professional	TC	$224.12	$281.30	$597.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $637.08 / $803.30 / $1,022.12	Professional		$637.08	$803.30	$1,022.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $533.10 / $684.27 / $861.39	Professional	TC	$533.10	$684.27	$861.39
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $862.09 / $1,083.93 / $1,403.40	Professional		$862.09	$1,083.93	$1,403.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $738.40 / $954.87 / $1,202.04	Professional	TC	$738.40	$954.87	$1,202.04
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $514.13 / $1,322.50 / $1,873.72	Professional		$514.13	$1,322.50	$1,873.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $453.34 / $1,156.25 / $1,638.18	Professional	TC	$453.34	$1,156.25	$1,638.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $465.03 / $931.00 / $1,632.00	Professional		$465.03	$931.00	$1,632.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $472.50 / $1,058.75 / $1,842.75	Professional	TC	$472.50	$1,058.75	$1,842.75
United Facility/Professional Professional Modifier Low / Median / High Price $817.70 / $934.80 / $1,765.30	Professional		$817.70	$934.80	$1,765.30
United Facility/Professional Professional Modifier TC Low / Median / High Price $689.12 / $821.38 / $1,487.71	Professional	TC	$689.12	$821.38	$1,487.71