Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $305.11 / $305.11 / $305.11	Facility	26	$305.11	$305.11	$305.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $2,424.85 / $2,424.85 / $5,496.30	Professional		$2,424.85	$2,424.85	$5,496.30
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $244.96 / $336.02 / $578.66	Professional	26	$244.96	$336.02	$578.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $2,088.83 / $2,088.83 / $4,917.58	Professional	TC	$2,088.83	$2,088.83	$4,917.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,315.69 / $2,315.69 / $2,736.69	Professional		$2,315.69	$2,315.69	$2,736.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $316.39 / $316.39 / $361.88	Professional	26	$316.39	$316.39	$361.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,999.31 / $1,999.31 / $2,374.81	Professional	TC	$1,999.31	$1,999.31	$2,374.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,257.80 / $2,331.87 / $4,205.25	Professional		$1,257.80	$2,331.87	$4,205.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $231.28 / $277.52 / $297.88	Professional	26	$231.28	$277.52	$297.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,711.95 / $2,054.34 / $2,204.98	Professional	TC	$1,711.95	$2,054.34	$2,204.98
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,003.75 / $3,329.10 / $4,397.49	Professional		$3,003.75	$3,329.10	$4,397.49
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $357.50 / $383.40 / $523.38	Professional	26	$357.50	$383.40	$523.38
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $2,646.25 / $2,945.70 / $3,874.11	Professional	TC	$2,646.25	$2,945.70	$3,874.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,257.80 / $3,310.00 / $6,050.68	Professional		$1,257.80	$3,310.00	$6,050.68
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $345.60 / $435.00 / $662.65	Professional	26	$345.60	$435.00	$662.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $2,374.81 / $3,537.00 / $5,388.03	Professional	TC	$2,374.81	$3,537.00	$5,388.03
United Facility/Professional Professional Modifier Low / Median / High Price $1,405.02 / $2,189.36 / $3,284.04	Professional		$1,405.02	$2,189.36	$3,284.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $153.87 / $289.04 / $434.25	Professional	26	$153.87	$289.04	$434.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,251.15 / $1,899.86 / $2,849.79	Professional	TC	$1,251.15	$1,899.86	$2,849.79