Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $354.81 / $354.81 / $354.81	Facility	26	$354.81	$354.81	$354.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $588.84 / $758.58 / $1,230.27	Professional		$588.84	$758.58	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $114.82 / $138.04 / $302.00	Professional	26	$114.82	$138.04	$302.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $645.65 / $645.65 / $645.65	Professional	52	$645.65	$645.65	$645.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $478.63 / $616.60 / $954.99	Professional	TC	$478.63	$616.60	$954.99
Cigna Facility/Professional Professional Modifier Low / Median / High Price $1,318.26 / $1,445.44 / $1,905.46	Professional		$1,318.26	$1,445.44	$1,905.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $295.12 / $331.13 / $446.68	Professional	26	$295.12	$331.13	$446.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $1,023.29 / $1,122.02 / $1,445.44	Professional	TC	$1,023.29	$1,122.02	$1,445.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $676.08 / $1,778.28 / $2,951.21	Professional		$676.08	$1,778.28	$2,951.21
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $125.89 / $371.54 / $630.96	Professional	26	$125.89	$371.54	$630.96
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $371.54 / $371.54 / $645.65	Professional	52	$371.54	$371.54	$645.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $549.54 / $1,445.44 / $2,344.23	Professional	TC	$549.54	$1,445.44	$2,344.23
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $1,258.93 / $2,630.27 / $3,311.31	Professional		$1,258.93	$2,630.27	$3,311.31
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $239.88 / $489.78 / $660.69	Professional	26	$239.88	$489.78	$660.69
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $2,137.96 / $2,691.53	Professional	TC	$1,000.00	$2,137.96	$2,691.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $1,445.44 / $1,819.70	Professional		$741.31	$1,445.44	$1,819.70
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $218.78 / $446.68	Professional	26	$120.23	$218.78	$446.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $489.78 / $954.99 / $1,445.44	Professional	TC	$489.78	$954.99	$1,445.44
United Facility/Professional Professional Modifier Low / Median / High Price $776.25 / $1,513.56 / $3,235.94	Professional		$776.25	$1,513.56	$3,235.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $177.83 / $354.81 / $776.25	Professional	26	$177.83	$354.81	$776.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $616.60 / $1,148.15 / $2,511.89	Professional	TC	$616.60	$1,148.15	$2,511.89