Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $692.06 / $692.06 / $692.06	Facility	26	$692.06	$692.06	$692.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $427.44 / $522.54 / $1,483.08	Professional		$427.44	$522.54	$1,483.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $188.34 / $220.12 / $792.66	Professional	26	$188.34	$220.12	$792.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $239.11 / $297.79 / $690.43	Professional	TC	$239.11	$297.79	$690.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,389.85 / $1,389.85 / $1,528.37	Professional		$1,389.85	$1,389.85	$1,528.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $671.94 / $671.94 / $791.28	Professional	26	$671.94	$671.94	$791.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $717.91 / $717.91 / $737.09	Professional	TC	$717.91	$717.91	$737.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $672.60 / $1,384.74 / $2,497.25	Professional		$672.60	$1,384.74	$2,497.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $550.70 / $660.84 / $709.30	Professional	26	$550.70	$660.84	$709.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $603.25 / $603.25 / $776.99	Professional	TC	$603.25	$603.25	$776.99
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,770.00 / $1,898.10 / $4,318.80	Professional		$1,770.00	$1,898.10	$4,318.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $800.00 / $905.85 / $1,952.00	Professional	26	$800.00	$905.85	$1,952.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $932.50 / $992.25 / $2,366.80	Professional	TC	$932.50	$992.25	$2,366.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,016.64 / $1,770.00 / $3,894.00	Professional		$1,016.64	$1,770.00	$3,894.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $791.28 / $966.00 / $1,952.00	Professional	26	$791.28	$966.00	$1,952.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $737.09 / $1,101.00 / $2,366.80	Professional	TC	$737.09	$1,101.00	$2,366.80
United Facility/Professional Professional Modifier Low / Median / High Price $703.57 / $1,834.05 / $6,996.53	Professional		$703.57	$1,834.05	$6,996.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $333.75 / $949.53 / $3,622.28	Professional	26	$333.75	$949.53	$3,622.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $369.82 / $884.52 / $3,374.25	Professional	TC	$369.82	$884.52	$3,374.25