Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $212.79 / $212.79 / $212.79	Facility	26	$212.79	$212.79	$212.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $463.49 / $550.14 / $1,320.54	Professional		$463.49	$550.14	$1,320.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.28 / $73.54 / $234.35	Professional	26	$64.28	$73.54	$234.35
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $399.20 / $476.60 / $1,058.91	Professional	TC	$399.20	$476.60	$1,058.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,242.50 / $1,242.50 / $1,466.07	Professional		$1,242.50	$1,242.50	$1,466.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $222.62 / $222.62 / $254.66	Professional	26	$222.62	$222.62	$254.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,019.87 / $1,019.87 / $1,211.41	Professional	TC	$1,019.87	$1,019.87	$1,211.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $668.33 / $1,237.26 / $2,231.25	Professional		$668.33	$1,237.26	$2,231.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $160.93 / $193.11 / $207.27	Professional	26	$160.93	$193.11	$207.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $870.13 / $1,044.15 / $1,120.72	Professional	TC	$870.13	$1,044.15	$1,120.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,593.75 / $1,761.75 / $2,333.25	Professional		$1,593.75	$1,761.75	$2,333.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $248.75 / $267.30 / $364.17	Professional	26	$248.75	$267.30	$364.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,345.00 / $1,494.45 / $1,969.08	Professional	TC	$1,345.00	$1,494.45	$1,969.08
Providence Facility/Professional Professional Modifier Low / Median / High Price $668.33 / $1,758.75 / $3,215.00	Professional		$668.33	$1,758.75	$3,215.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $240.00 / $306.00 / $466.14	Professional	26	$240.00	$306.00	$466.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $1,211.41 / $1,804.50 / $2,748.86	Professional	TC	$1,211.41	$1,804.50	$2,748.86
United Facility/Professional Professional Modifier Low / Median / High Price $746.55 / $1,169.40 / $1,759.29	Professional		$746.55	$1,169.40	$1,759.29
United Facility/Professional Professional Modifier 26 Low / Median / High Price $108.25 / $203.38 / $305.58	Professional	26	$108.25	$203.38	$305.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $638.29 / $966.02 / $1,453.71	Professional	TC	$638.29	$966.02	$1,453.71