Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $276.58 / $622.70 / $1,178.96	Facility	26	$276.58	$622.70	$1,178.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $306.68 / $435.25 / $1,289.78	Professional		$306.68	$435.25	$1,289.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.45 / $106.05 / $461.13	Professional	26	$76.45	$106.05	$461.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $230.22 / $286.63 / $834.50	Professional	TC	$230.22	$286.63	$834.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $460.53 / $825.00 / $1,147.88	Professional		$460.53	$825.00	$1,147.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.47 / $247.50 / $297.38	Professional	26	$131.47	$247.50	$297.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $329.06 / $577.50 / $850.50	Professional	TC	$329.06	$577.50	$850.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $739.84 / $891.78 / $1,979.00	Professional		$739.84	$891.78	$1,979.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $208.63 / $250.35 / $625.85	Professional	26	$208.63	$250.35	$625.85
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $496.24 / $641.42 / $1,320.11	Professional	TC	$496.24	$641.42	$1,320.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,123.75 / $1,260.90 / $2,058.44	Professional		$1,123.75	$1,260.90	$2,058.44
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $322.50 / $348.30 / $578.87	Professional	26	$322.50	$348.30	$578.87
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $798.75 / $916.65 / $1,479.57	Professional	TC	$798.75	$916.65	$1,479.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $431.62 / $1,142.40 / $1,861.00	Professional		$431.62	$1,142.40	$1,861.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $247.50 / $388.50 / $578.87	Professional	26	$247.50	$388.50	$578.87
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $653.50 / $993.00 / $1,479.57	Professional	TC	$653.50	$993.00	$1,479.57
United Facility/Professional Professional Modifier Low / Median / High Price $550.69 / $1,134.42 / $2,200.00	Professional		$550.69	$1,134.42	$2,200.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $138.49 / $384.33 / $746.00	Professional	26	$138.49	$384.33	$746.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $420.51 / $533.54 / $1,186.51	Professional	TC	$420.51	$533.54	$1,186.51