Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.94 / $1,470.25 / $1,940.40	Facility		$275.94	$1,470.25	$1,940.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.59 / $94.51 / $352.27	Facility	26	$75.59	$94.51	$352.27
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $245.96 / $766.17 / $1,564.04	Facility	TC	$245.96	$766.17	$1,564.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $205.65 / $274.08 / $655.88	Professional		$205.65	$274.08	$655.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.33 / $43.65 / $133.50	Professional	26	$35.33	$43.65	$133.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.96 / $232.17 / $356.25	Professional	TC	$169.96	$232.17	$356.25
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 $181.86 / $293.14 / $576.62	Professional		$181.86	$293.14	$576.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.58 / $49.52 / $120.50	Professional	26	$33.58	$49.52	$120.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $148.28 / $237.68 / $456.12	Professional	TC	$148.28	$237.68	$456.12
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $201.59 / $366.93 / $513.70	Facility		$201.59	$366.93	$513.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $433.42 / $536.64 / $1,044.04	Professional		$433.42	$536.64	$1,044.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.63 / $93.15 / $217.05	Professional	26	$77.63	$93.15	$217.05
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $369.55 / $443.46 / $826.99	Professional	TC	$369.55	$443.46	$826.99
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $579.70 / $757.35 / $1,011.99	Professional		$579.70	$757.35	$1,011.99
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $110.00 / $130.94 / $175.67	Professional	26	$110.00	$130.94	$175.67
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $469.70 / $626.40 / $836.31	Professional	TC	$469.70	$626.40	$836.31
Providence Facility/Professional Facility Modifier Low / Median / High Price $210.98 / $366.93 / $524.71	Facility		$210.98	$366.93	$524.71
Providence Facility/Professional Professional Modifier Low / Median / High Price $222.02 / $553.70 / $989.46	Professional		$222.02	$553.70	$989.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.71 / $143.55 / $188.55	Professional	26	$62.71	$143.55	$188.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $248.05 / $669.90 / $871.57	Professional	TC	$248.05	$669.90	$871.57
United Facility/Professional Professional Modifier Low / Median / High Price $332.01 / $461.30 / $922.60	Professional		$332.01	$461.30	$922.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.70 / $96.40 / $208.11	Professional	26	$46.70	$96.40	$208.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $308.33 / $364.90 / $729.80	Professional	TC	$308.33	$364.90	$729.80