Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $2,464.00 / $6,782.00 / $13,413.92	Facility		$2,464.00	$6,782.00	$13,413.92
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $120.56 / $120.56 / $120.56	Facility	26	$120.56	$120.56	$120.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.13 / $287.98 / $807.58	Professional		$140.13	$287.98	$807.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.96 / $48.19 / $190.66	Professional	26	$41.96	$48.19	$190.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $98.17 / $119.75 / $616.91	Professional	TC	$98.17	$119.75	$616.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $489.29 / $489.29 / $489.29	Professional		$489.29	$489.29	$489.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $120.69 / $120.69 / $141.28	Professional	26	$120.69	$120.69	$141.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $181.27 / $181.27 / $348.00	Professional	TC	$181.27	$181.27	$348.00
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $183.87 / $807.58 / $1,154.83	Facility		$183.87	$807.58	$1,154.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $402.73 / $1,045.80 / $1,367.54	Professional		$402.73	$1,045.80	$1,367.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.63 / $151.91 / $332.22	Professional	26	$94.63	$151.91	$332.22
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $308.10 / $399.66 / $1,035.32	Professional	TC	$308.10	$399.66	$1,035.32
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $622.50 / $722.10 / $888.00	Professional		$622.50	$722.10	$888.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $146.25 / $169.65 / $255.20	Professional	26	$146.25	$169.65	$255.20
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $404.00 / $552.45 / $697.23	Professional	TC	$404.00	$552.45	$697.23
Providence Facility/Professional Facility Modifier Low / Median / High Price $183.87 / $807.58 / $1,154.83	Facility		$183.87	$807.58	$1,154.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $187.63 / $691.50 / $886.96	Professional		$187.63	$691.50	$886.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $145.00 / $193.05 / $265.06	Professional	26	$145.00	$193.05	$265.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $361.80 / $517.50 / $714.00	Professional	TC	$361.80	$517.50	$714.00
United Facility/Professional Professional Modifier Low / Median / High Price $280.58 / $587.13 / $693.00	Professional		$280.58	$587.13	$693.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $100.53 / $169.53 / $280.00	Professional	26	$100.53	$169.53	$280.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $198.96 / $384.74 / $417.60	Professional	TC	$198.96	$384.74	$417.60