Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $319.66 / $319.66 / $319.66	Facility	26	$319.66	$319.66	$319.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,556.18 / $1,556.18 / $1,876.56	Professional		$1,556.18	$1,556.18	$1,876.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $505.56 / $505.56 / $704.48	Professional	26	$505.56	$505.56	$704.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $1,050.61 / $1,050.61 / $1,315.67	Professional	TC	$1,050.61	$1,050.61	$1,315.67
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,059.83 / $1,059.83 / $1,059.83	Professional		$1,059.83	$1,059.83	$1,059.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $325.24 / $325.24 / $374.74	Professional	26	$325.24	$325.24	$374.74
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $520.39 / $520.39 / $685.09	Professional	TC	$520.39	$520.39	$685.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $825.65 / $2,144.10 / $2,688.40	Professional		$825.65	$2,144.10	$2,688.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $253.10 / $403.68 / $884.39	Professional	26	$253.10	$403.68	$884.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $572.53 / $741.75 / $1,804.01	Professional	TC	$572.53	$741.75	$1,804.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,276.25 / $1,482.30 / $2,018.85	Professional		$1,276.25	$1,482.30	$2,018.85
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $391.25 / $453.85 / $675.40	Professional	26	$391.25	$453.85	$675.40
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $885.00 / $1,059.75 / $1,360.95	Professional	TC	$885.00	$1,059.75	$1,360.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $446.03 / $1,482.00 / $2,093.96	Professional		$446.03	$1,482.00	$2,093.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $382.50 / $513.15 / $701.50	Professional	26	$382.50	$513.15	$701.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $943.20 / $1,144.00 / $1,394.68	Professional	TC	$943.20	$1,144.00	$1,394.68
United Facility/Professional Professional Modifier Low / Median / High Price $770.48 / $1,271.82 / $1,772.10	Professional		$770.48	$1,271.82	$1,772.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $299.77 / $299.80 / $689.49	Professional	26	$299.77	$299.80	$689.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $470.70 / $822.12 / $1,082.60	Professional	TC	$470.70	$822.12	$1,082.60