Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $181.65 / $181.65 / $181.65	Facility		$181.65	$181.65	$181.65
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $112.64 / $112.64 / $112.64	Facility	26	$112.64	$112.64	$112.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $58.82 / $212.06 / $287.26	Professional		$58.82	$212.06	$287.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.31 / $77.98 / $178.13	Professional	26	$33.31	$77.98	$178.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.90 / $109.13 / $148.66	Professional	TC	$24.90	$109.13	$148.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $159.71 / $159.71 / $215.81	Professional		$159.71	$159.71	$215.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.04 / $133.51 / $231.77	Professional	26	$97.04	$133.51	$231.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.67 / $82.30 / $289.89	Professional	TC	$62.67	$82.30	$289.89
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $76.19 / $287.26 / $439.51	Facility		$76.19	$287.26	$439.51
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $155.28 / $186.33 / $374.40	Professional		$155.28	$186.33	$374.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.15 / $105.78 / $165.66	Professional	26	$88.15	$105.78	$165.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $63.49 / $80.55 / $101.01	Professional	TC	$63.49	$80.55	$101.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.00 / $248.22 / $370.50	Professional		$95.00	$248.22	$370.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $54.50 / $140.34 / $210.60	Professional	26	$54.50	$140.34	$210.60
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $60.30 / $112.05 / $175.50	Professional	TC	$60.30	$112.05	$175.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $76.19 / $287.26 / $439.51	Facility		$76.19	$287.26	$439.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.10 / $168.30 / $386.10	Professional		$89.10	$168.30	$386.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $72.36 / $136.25 / $257.04	Professional	26	$72.36	$136.25	$257.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $63.99 / $112.14 / $214.20	Professional	TC	$63.99	$112.14	$214.20
United Facility/Professional Professional Modifier Low / Median / High Price $164.09 / $172.64 / $258.95	Professional		$164.09	$172.64	$258.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $105.78 / $106.80 / $160.19	Professional	26	$105.78	$106.80	$160.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $65.84 / $65.84 / $98.76	Professional	TC	$65.84	$65.84	$98.76