Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $315.64 / $315.64 / $344.64	Facility	26	$315.64	$315.64	$344.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $581.88 / $821.91 / $1,240.79	Professional		$581.88	$821.91	$1,240.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $116.66 / $136.03 / $281.82	Professional	26	$116.66	$136.03	$281.82
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $284.83 / $388.94 / $620.40	Professional	52	$284.83	$388.94	$620.40
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $465.22 / $654.21 / $958.97	Professional	TC	$465.22	$654.21	$958.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,312.70 / $1,452.69 / $1,895.01	Professional		$1,312.70	$1,452.69	$1,895.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $293.83 / $330.41 / $447.02	Professional	26	$293.83	$330.41	$447.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,018.86 / $1,122.28 / $1,448.00	Professional	TC	$1,018.86	$1,122.28	$1,448.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $1,547.94 / $1,911.69 / $2,519.90	Professional		$1,547.94	$1,911.69	$2,519.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $292.73 / $351.27 / $560.80	Professional	26	$292.73	$351.27	$560.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,203.42 / $1,560.39 / $1,959.06	Professional	TC	$1,203.42	$1,560.39	$1,959.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $894.35 / $2,462.50 / $3,331.25	Professional		$894.35	$2,462.50	$3,331.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $164.98 / $452.50 / $662.46	Professional	26	$164.98	$452.50	$662.46
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $729.37 / $2,010.00 / $2,932.80	Professional	TC	$729.37	$2,010.00	$2,932.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $838.80 / $1,638.99 / $3,331.25	Professional		$838.80	$1,638.99	$3,331.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $180.50 / $451.25 / $822.60	Professional	26	$180.50	$451.25	$822.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $757.50 / $1,846.80 / $2,954.25	Professional	TC	$757.50	$1,846.80	$2,954.25
United Facility/Professional Professional Modifier Low / Median / High Price $1,516.02 / $1,631.61 / $3,272.87	Professional		$1,516.02	$1,631.61	$3,272.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $309.30 / $357.62 / $772.05	Professional	26	$309.30	$357.62	$772.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $1,158.40 / $1,322.31 / $2,500.82	Professional	TC	$1,158.40	$1,322.31	$2,500.82