Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.94 / $411.34 / $1,729.70	Facility		$275.94	$411.34	$1,729.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.45 / $199.98 / $1,404.54	Facility	26	$104.45	$199.98	$1,404.54
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $465.78 / $1,173.63 / $1,816.58	Facility	TC	$465.78	$1,173.63	$1,816.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.83 / $356.45 / $786.00	Professional		$199.83	$356.45	$786.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.65 / $47.61 / $151.60	Professional	26	$29.65	$47.61	$151.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.77 / $308.85 / $399.91	Professional	TC	$169.77	$308.85	$399.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,060.27 / $1,060.27 / $1,060.27	Facility		$1,060.27	$1,060.27	$1,060.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $239.78 / $359.63 / $747.10	Professional		$239.78	$359.63	$747.10
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.00 / $56.87 / $137.06	Professional	26	$38.00	$56.87	$137.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $201.65 / $321.63 / $610.04	Professional	TC	$201.65	$321.63	$610.04
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $256.82 / $466.28 / $652.79	Facility		$256.82	$466.28	$652.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $552.16 / $687.03 / $1,335.32	Professional		$552.16	$687.03	$1,335.32
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.95 / $106.74 / $248.21	Professional	26	$88.95	$106.74	$248.21
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $483.58 / $580.29 / $1,087.16	Professional	TC	$483.58	$580.29	$1,087.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $761.20 / $973.35 / $1,303.75	Professional		$761.20	$973.35	$1,303.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $122.04 / $149.85 / $201.30	Professional	26	$122.04	$149.85	$201.30
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $636.90 / $823.50 / $1,106.00	Professional	TC	$636.90	$823.50	$1,106.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $256.82 / $466.28 / $666.78	Facility		$256.82	$466.28	$666.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $291.82 / $705.60 / $1,303.75	Professional		$291.82	$705.60	$1,303.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.23 / $162.40 / $213.56	Professional	26	$71.23	$162.40	$213.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $323.22 / $909.00 / $1,169.20	Professional	TC	$323.22	$909.00	$1,169.20
United Facility/Professional Professional Modifier Low / Median / High Price $440.39 / $597.67 / $1,195.35	Professional		$440.39	$597.67	$1,195.35
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.06 / $109.66 / $219.32	Professional	26	$40.06	$109.66	$219.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $405.32 / $488.02 / $923.65	Professional	TC	$405.32	$488.02	$923.65