Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $335.73 / $335.73 / $335.73	Facility	26	$335.73	$335.73	$335.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $475.00 / $522.50 / $2,459.89	Professional		$475.00	$522.50	$2,459.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $140.00 / $154.00 / $658.14	Professional	26	$140.00	$154.00	$658.14
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $335.00 / $368.50 / $1,801.75	Professional	TC	$335.00	$368.50	$1,801.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $714.75 / $1,125.00 / $1,798.14	Professional		$714.75	$1,125.00	$1,798.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $163.36 / $337.50 / $367.33	Professional	26	$163.36	$337.50	$367.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $551.40 / $787.50 / $1,430.81	Professional	TC	$551.40	$787.50	$1,430.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,132.85 / $1,384.74 / $2,989.09	Professional		$1,132.85	$1,384.74	$2,989.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $258.77 / $316.06 / $777.10	Professional	26	$258.77	$316.06	$777.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $830.87 / $1,074.24 / $2,211.94	Professional	TC	$830.87	$1,074.24	$2,211.94
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,783.75 / $2,073.50 / $3,482.13	Professional		$1,783.75	$2,073.50	$3,482.13
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $400.00 / $432.00 / $722.25	Professional	26	$400.00	$432.00	$722.25
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,383.75 / $1,656.20 / $2,771.40	Professional	TC	$1,383.75	$1,656.20	$2,771.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $662.98 / $1,818.75 / $3,416.35	Professional		$662.98	$1,818.75	$3,416.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $337.50 / $477.00 / $710.73	Professional	26	$337.50	$477.00	$710.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,249.56 / $1,860.00 / $2,771.40	Professional	TC	$1,249.56	$1,860.00	$2,771.40
United Facility/Professional Professional Modifier Low / Median / High Price $1,315.60 / $1,600.94 / $2,795.65	Professional		$1,315.60	$1,600.94	$2,795.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $151.76 / $394.95 / $671.42	Professional	26	$151.76	$394.95	$671.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $999.64 / $1,273.97 / $2,073.10	Professional	TC	$999.64	$1,273.97	$2,073.10