Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $265.97 / $558.13 / $714.60	Facility		$265.97	$558.13	$714.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.15 / $27.15 / $27.15	Facility	26	$27.15	$27.15	$27.15
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $69.01 / $265.97 / $401.60	Facility	TC	$69.01	$265.97	$401.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.50 / $40.93 / $136.82	Professional		$33.50	$40.93	$136.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.61 / $12.41 / $37.38	Professional	26	$10.61	$12.41	$37.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.87 / $28.52 / $82.06	Professional	TC	$22.87	$28.52	$82.06
Cigna Facility/Professional Facility Modifier Low / Median / High Price $466.44 / $466.44 / $466.44	Facility		$466.44	$466.44	$466.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.43 / $103.57 / $127.23	Professional		$54.43	$103.57	$127.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $30.06 / $38.52	Professional	26	$13.25	$30.06	$38.52
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $41.18 / $65.06 / $97.17	Professional	TC	$41.18	$65.06	$97.17
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $39.89 / $39.89 / $151.44	Facility		$39.89	$39.89	$151.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.76 / $104.79 / $222.09	Professional		$85.76	$104.79	$222.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $27.33 / $74.81	Professional	26	$22.54	$27.33	$74.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.30 / $79.56 / $187.59	Professional	TC	$61.30	$79.56	$187.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $145.80 / $231.75	Professional		$133.75	$145.80	$231.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $45.00 / $72.00	Professional	26	$32.50	$45.00	$72.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $88.75 / $110.70 / $158.69	Professional	TC	$88.75	$110.70	$158.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $39.89 / $47.87 / $466.44	Facility		$39.89	$47.87	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $49.26 / $129.60 / $223.50	Professional		$49.26	$129.60	$223.50
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.20 / $43.50 / $72.00	Professional	26	$31.20	$43.50	$72.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.00 / $106.50 / $158.69	Professional	TC	$71.00	$106.50	$158.69
United Facility/Professional Professional Modifier Low / Median / High Price $50.40 / $92.80 / $177.00	Professional		$50.40	$92.80	$177.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.39 / $35.04 / $70.00	Professional	26	$15.39	$35.04	$70.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.92 / $71.20 / $107.00	Professional	TC	$36.92	$71.20	$107.00