Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $186.21 / $186.21 / $186.21	Facility		$186.21	$186.21	$186.21
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $114.82 / $114.82 / $114.82	Facility	26	$114.82	$114.82	$114.82
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $87.10 / $234.42	Professional		$61.66	$87.10	$234.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $47.86 / $100.00	Professional	26	$34.67	$47.86	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $40.74 / $147.91	Professional	TC	$25.12	$40.74	$147.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $213.80	Professional		$158.49	$158.49	$213.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $134.90 / $234.42	Professional	26	$97.72	$134.90	$234.42
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $83.18 / $288.40	Professional	TC	$63.10	$83.18	$288.40
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $66.07 / $257.04 / $501.19	Facility		$66.07	$257.04	$501.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $199.53 / $389.05	Professional		$77.62	$199.53	$389.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $109.65 / $181.97	Professional	26	$45.71	$109.65	$181.97
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $77.62 / $147.91	Professional	TC	$33.88	$77.62	$147.91
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $263.03 / $371.54	Professional		$134.90	$263.03	$371.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $147.91 / $208.93	Professional	26	$74.13	$147.91	$208.93
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $112.20 / $173.78	Professional	TC	$61.66	$112.20	$173.78
Providence Facility/Professional Facility Modifier Low / Median / High Price $63.10 / $125.89 / $436.52	Facility		$63.10	$125.89	$436.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $158.49 / $199.53	Professional		$74.13	$158.49	$199.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $66.07 / $234.42	Professional	26	$36.31	$66.07	$234.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $51.29 / $288.40	Professional	TC	$28.18	$51.29	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $173.78 / $275.42	Professional		$100.00	$173.78	$275.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $107.15 / $158.49	Professional	26	$93.33	$107.15	$158.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $112.20	Professional	TC	$66.07	$66.07	$112.20