Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $316.23 / $316.23 / $316.23	Facility	26	$316.23	$316.23	$316.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,047.13 / $2,238.72	Professional		$812.83	$1,047.13	$2,238.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $162.18 / $416.87	Professional	26	$134.90	$162.18	$416.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $870.96 / $1,513.56	Professional	TC	$616.60	$870.96	$1,513.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,862.09 / $2,570.40	Professional		$812.83	$1,862.09	$2,570.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $186.21 / $389.05 / $446.68	Professional	26	$186.21	$389.05	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $1,445.44 / $2,187.76	Professional	TC	$630.96	$1,445.44	$2,187.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $2,137.96 / $3,162.28	Professional		$1,318.26	$2,137.96	$3,162.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $199.53 / $354.81 / $562.34	Professional	26	$199.53	$354.81	$562.34
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $1,479.11 / $1,479.11 / $1,479.11	Professional	52	$1,479.11	$1,479.11	$1,479.11
Moda Health Facility/Professional Professional Modifier 53 Low / Median / High Price $549.54 / $549.54 / $549.54	Professional	53	$549.54	$549.54	$549.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,122.02 / $1,819.70 / $2,630.27	Professional	TC	$1,122.02	$1,819.70	$2,630.27
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $2,818.38 / $3,019.95 / $4,570.88	Professional		$2,818.38	$3,019.95	$4,570.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $478.63 / $707.95	Professional	26	$446.68	$478.63	$707.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $2,344.23 / $2,511.89 / $3,890.45	Professional	TC	$2,344.23	$2,511.89	$3,890.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $812.83 / $1,819.70 / $2,238.72	Professional		$812.83	$1,819.70	$2,238.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $186.21 / $446.68	Professional	26	$109.65	$186.21	$446.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $630.96 / $1,023.29 / $2,089.30	Professional	TC	$630.96	$1,023.29	$2,089.30
United Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $2,137.96 / $4,677.35	Professional		$1,905.46	$2,137.96	$4,677.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $281.84 / $371.54 / $870.96	Professional	26	$281.84	$371.54	$870.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,621.81 / $1,778.28 / $3,890.45	Professional	TC	$1,621.81	$1,778.28	$3,890.45