Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $252.63 / $252.63 / $252.63	Facility	26	$252.63	$252.63	$252.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $481.64 / $594.37 / $1,363.30	Professional		$481.64	$594.37	$1,363.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.73 / $79.06 / $332.25	Professional	26	$67.73	$79.06	$332.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $413.91 / $515.29 / $1,073.94	Professional	TC	$413.91	$515.29	$1,073.94
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,377.49 / $1,377.49 / $1,470.72	Professional		$1,377.49	$1,377.49	$1,470.72
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $243.39 / $243.39 / $289.35	Professional	26	$243.39	$243.39	$289.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,134.09 / $1,134.09 / $1,181.38	Professional	TC	$1,134.09	$1,134.09	$1,181.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $685.43 / $1,282.85 / $2,313.50	Professional		$685.43	$1,282.85	$2,313.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $200.55 / $240.66 / $258.31	Professional	26	$200.55	$240.66	$258.31
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $868.50 / $1,042.20 / $1,118.63	Professional	TC	$868.50	$1,042.20	$1,118.63
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,652.50 / $1,813.05 / $4,401.14	Professional		$1,652.50	$1,813.05	$4,401.14
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $291.25 / $330.75 / $710.65	Professional	26	$291.25	$330.75	$710.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,342.50 / $1,512.50 / $3,690.50	Professional	TC	$1,342.50	$1,512.50	$3,690.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,033.58 / $1,803.75 / $3,968.25	Professional		$1,033.58	$1,803.75	$3,968.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $289.35 / $354.00 / $710.65	Professional	26	$289.35	$354.00	$710.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,181.38 / $1,758.00 / $3,690.50	Professional	TC	$1,181.38	$1,758.00	$3,690.50
United Facility/Professional Professional Modifier Low / Median / High Price $637.79 / $1,764.87 / $6,732.63	Professional		$637.79	$1,764.87	$6,732.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $103.47 / $347.22 / $1,324.58	Professional	26	$103.47	$347.22	$1,324.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $534.32 / $1,015.96 / $5,408.05	Professional	TC	$534.32	$1,015.96	$5,408.05