Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $775.10 / $775.10 / $775.10	Facility	26	$775.10	$775.10	$775.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $1,133.92 / $1,175.74 / $2,255.21	Professional		$1,133.92	$1,175.74	$2,255.21
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $318.36 / $388.87 / $4,044.60	Professional	26	$318.36	$388.87	$4,044.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $815.25 / $857.38 / $1,557.26	Professional	TC	$815.25	$857.38	$1,557.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $2,171.61 / $2,171.61 / $3,215.95	Professional		$2,171.61	$2,171.61	$3,215.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $701.89 / $701.89 / $1,013.99	Professional	26	$701.89	$701.89	$1,013.99
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,469.71 / $1,469.71 / $2,201.96	Professional	TC	$1,469.71	$1,469.71	$2,201.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $2,407.40 / $6,251.70 / $7,459.99	Professional		$2,407.40	$6,251.70	$7,459.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $693.83 / $1,078.38 / $2,364.44	Professional	26	$693.83	$1,078.38	$2,364.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,713.55 / $2,220.44 / $5,095.60	Professional	TC	$1,713.55	$2,220.44	$5,095.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,721.25 / $4,316.64 / $6,090.00	Professional		$3,721.25	$4,316.64	$6,090.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $1,072.50 / $1,244.09 / $1,928.95	Professional	26	$1,072.50	$1,244.09	$1,928.95
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $2,648.75 / $3,072.55 / $4,649.55	Professional	TC	$2,648.75	$3,072.55	$4,649.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $1,400.09 / $4,561.50 / $6,578.50	Professional		$1,400.09	$4,561.50	$6,578.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $1,026.00 / $1,293.00 / $2,056.32	Professional	26	$1,026.00	$1,293.00	$2,056.32
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $2,606.25 / $3,525.00 / $4,793.32	Professional	TC	$2,606.25	$3,525.00	$4,793.32
United Facility/Professional Professional Modifier Low / Median / High Price $2,435.14 / $2,572.76 / $4,653.10	Professional		$2,435.14	$2,572.76	$4,653.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $499.83 / $811.20 / $1,467.14	Professional	26	$499.83	$811.20	$1,467.14
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,618.54 / $1,761.56 / $3,185.97	Professional	TC	$1,618.54	$1,761.56	$3,185.97