Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $351.03 / $351.03 / $351.03	Facility	26	$351.03	$351.03	$351.03
Aetna Facility/Professional Professional Modifier Low / Median / High Price $414.14 / $507.59 / $1,138.93	Professional		$414.14	$507.59	$1,138.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $104.37 / $172.62 / $599.34	Professional	26	$104.37	$172.62	$599.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $309.76 / $385.70 / $639.45	Professional	TC	$309.76	$385.70	$639.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $627.29 / $973.00 / $1,519.59	Professional		$627.29	$973.00	$1,519.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $170.20 / $276.00 / $384.29	Professional	26	$170.20	$276.00	$384.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $457.09 / $681.10 / $1,135.30	Professional	TC	$457.09	$681.10	$1,135.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,004.63 / $1,213.95 / $2,626.03	Professional		$1,004.63	$1,213.95	$2,626.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $270.10 / $331.34 / $815.98	Professional	26	$270.10	$331.34	$815.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $688.02 / $889.86 / $1,810.05	Professional	TC	$688.02	$889.86	$1,810.05
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,556.25 / $1,706.40 / $2,791.52	Professional		$1,556.25	$1,706.40	$2,791.52
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $417.50 / $450.90 / $748.73	Professional	26	$417.50	$450.90	$748.73
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,135.00 / $1,258.20 / $2,042.79	Professional	TC	$1,135.00	$1,258.20	$2,042.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $582.46 / $1,527.60 / $2,516.85	Professional		$582.46	$1,527.60	$2,516.85
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $291.89 / $502.50 / $748.73	Professional	26	$291.89	$502.50	$748.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $842.00 / $1,371.00 / $2,042.79	Professional	TC	$842.00	$1,371.00	$2,042.79
United Facility/Professional Professional Modifier Low / Median / High Price $1,064.85 / $1,597.29 / $2,556.01	Professional		$1,064.85	$1,597.29	$2,556.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $163.93 / $499.32 / $795.58	Professional	26	$163.93	$499.32	$795.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $736.57 / $1,104.86 / $1,760.43	Professional	TC	$736.57	$1,104.86	$1,760.43