Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $68.09 / $269.60 / $791.84	Facility		$68.09	$269.60	$791.84
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.83 / $37.38 / $63.18	Facility	26	$27.83	$37.38	$63.18
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $60.04 / $301.99 / $621.87	Facility	TC	$60.04	$301.99	$621.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $17.78 / $21.06 / $84.18	Professional		$17.78	$21.06	$84.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.08 / $9.89 / $39.47	Professional	26	$8.08	$9.89	$39.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $9.69 / $11.72 / $73.34	Professional	TC	$9.69	$11.72	$73.34
Cigna Facility/Professional Facility Modifier Low / Median / High Price $386.22 / $386.22 / $386.22	Facility		$386.22	$386.22	$386.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $39.54 / $53.11 / $91.04	Professional		$39.54	$53.11	$91.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $27.96 / $32.02	Professional	26	$13.25	$27.96	$32.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $25.15 / $26.29 / $60.98	Professional	TC	$25.15	$26.29	$60.98
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $29.40 / $190.80 / $525.91	Facility		$29.40	$190.80	$525.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $25.23 / $64.68 / $161.69	Professional		$25.23	$64.68	$161.69
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $30.70 / $63.08	Professional	26	$22.54	$30.70	$63.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $25.23 / $48.65 / $100.38	Professional	TC	$25.23	$48.65	$100.38
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $87.50 / $105.30 / $150.15	Professional		$87.50	$105.30	$150.15
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $37.70 / $58.11	Professional	26	$32.50	$37.70	$58.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $55.00 / $70.20 / $99.45	Professional	TC	$55.00	$70.20	$99.45
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.40 / $35.28 / $386.22	Facility		$29.40	$35.28	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $33.25 / $79.50 / $138.53	Professional		$33.25	$79.50	$138.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $39.00 / $59.02	Professional	26	$26.00	$39.00	$59.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.00 / $69.00 / $98.56	Professional	TC	$39.00	$69.00	$98.56
United Facility/Professional Professional Modifier Low / Median / High Price $29.88 / $78.00 / $156.86	Professional		$29.88	$78.00	$156.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $13.80 / $26.67 / $64.40	Professional	26	$13.80	$26.67	$64.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.60 / $42.99 / $79.08	Professional	TC	$16.60	$42.99	$79.08