Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $314.89 / $314.89 / $314.89	Facility	26	$314.89	$314.89	$314.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $312.81 / $373.79 / $1,563.66	Professional		$312.81	$373.79	$1,563.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $105.87 / $121.40 / $540.29	Professional	26	$105.87	$121.40	$540.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $206.93 / $252.38 / $1,055.97	Professional	TC	$206.93	$252.38	$1,055.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,073.18 / $1,073.18 / $1,073.18	Professional		$1,073.18	$1,073.18	$1,073.18
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $317.38 / $317.38 / $369.93	Professional	26	$317.38	$317.38	$369.93
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $525.37 / $525.37 / $703.25	Professional	TC	$525.37	$525.37	$703.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $821.60 / $2,133.60 / $2,676.44	Professional		$821.60	$2,133.60	$2,676.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $247.45 / $398.25 / $870.09	Professional	26	$247.45	$398.25	$870.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $574.15 / $743.85 / $1,806.35	Professional	TC	$574.15	$743.85	$1,806.35
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,270.00 / $1,473.20 / $2,053.25	Professional		$1,270.00	$1,473.20	$2,053.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $382.50 / $443.70 / $664.40	Professional	26	$382.50	$443.70	$664.40
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $887.50 / $1,061.09 / $1,406.10	Professional	TC	$887.50	$1,061.09	$1,406.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $453.63 / $1,500.00 / $2,129.65	Professional		$453.63	$1,500.00	$2,129.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $376.25 / $501.60 / $690.07	Professional	26	$376.25	$501.60	$690.07
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $948.00 / $1,174.00 / $1,447.04	Professional	TC	$948.00	$1,174.00	$1,447.04
United Facility/Professional Professional Modifier Low / Median / High Price $784.44 / $939.97 / $1,804.21	Professional		$784.44	$939.97	$1,804.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $261.20 / $296.06 / $680.94	Professional	26	$261.20	$296.06	$680.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $488.38 / $843.90 / $1,123.27	Professional	TC	$488.38	$843.90	$1,123.27