Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $356.12 / $356.12 / $356.12	Facility	26	$356.12	$356.12	$356.12
Aetna Facility/Professional Professional Modifier Low / Median / High Price $307.06 / $885.43 / $923.80	Professional		$307.06	$885.43	$923.80
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $106.23 / $506.71 / $506.71	Professional	26	$106.23	$506.71	$506.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.35 / $378.72 / $461.19	Professional	TC	$190.35	$378.72	$461.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $459.00 / $700.00 / $1,578.55	Professional		$459.00	$700.00	$1,578.55
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $137.69 / $210.00 / $390.32	Professional	26	$137.69	$210.00	$390.32
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $321.30 / $490.00 / $1,188.23	Professional	TC	$321.30	$490.00	$1,188.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $735.88 / $1,212.99 / $2,651.99	Professional		$735.88	$1,212.99	$2,651.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $274.95 / $336.06 / $824.67	Professional	26	$274.95	$336.06	$824.67
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $683.10 / $883.05 / $1,827.38	Professional	TC	$683.10	$883.05	$1,827.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,562.50 / $1,784.90 / $3,003.84	Professional		$1,562.50	$1,784.90	$3,003.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $425.00 / $459.00 / $759.90	Professional	26	$425.00	$459.00	$759.90
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,137.50 / $1,320.80 / $2,243.94	Professional	TC	$1,137.50	$1,320.80	$2,243.94
Providence Facility/Professional Professional Modifier Low / Median / High Price $588.23 / $1,595.00 / $2,889.60	Professional		$588.23	$1,595.00	$2,889.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $266.23 / $510.00 / $759.90	Professional	26	$266.23	$510.00	$759.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,011.91 / $1,506.00 / $2,243.94	Professional	TC	$1,011.91	$1,506.00	$2,243.94
United Facility/Professional Professional Modifier Low / Median / High Price $618.79 / $1,719.66 / $2,739.99	Professional		$618.79	$1,719.66	$2,739.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $162.37 / $505.38 / $805.24	Professional	26	$162.37	$505.38	$805.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $467.12 / $1,214.28 / $1,934.75	Professional	TC	$467.12	$1,214.28	$1,934.75