Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $99.93 / $435.12 / $742.50	Facility		$99.93	$435.12	$742.50
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.46 / $46.06 / $46.06	Facility	26	$33.46	$46.06	$46.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.19 / $35.61 / $137.56	Professional		$29.19	$35.61	$137.56
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.41 / $12.21 / $44.01	Professional	26	$9.41	$12.21	$44.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.76 / $24.65 / $111.22	Professional	TC	$19.76	$24.65	$111.22
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 $55.39 / $90.15 / $130.66	Professional		$55.39	$90.15	$130.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $34.43 / $39.45	Professional	26	$16.20	$34.43	$39.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $55.72 / $93.55	Professional	TC	$39.20	$55.72	$93.55
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $41.13 / $41.13 / $157.37	Facility		$41.13	$41.13	$157.37
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $88.95 / $106.74 / $228.97	Professional		$88.95	$106.74	$228.97
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $31.52 / $89.90	Professional	26	$25.88	$31.52	$89.90
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $59.66 / $75.69 / $180.70	Professional	TC	$59.66	$75.69	$180.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $121.25 / $148.50 / $223.50	Professional		$121.25	$148.50	$223.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.00 / $46.40 / $71.52	Professional	26	$40.00	$46.40	$71.52
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $81.25 / $106.65 / $151.97	Professional	TC	$81.25	$106.65	$151.97
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.13 / $49.36 / $386.22	Facility		$41.13	$49.36	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.34 / $121.25 / $216.20	Professional		$47.34	$121.25	$216.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $48.00 / $72.64	Professional	26	$32.00	$48.00	$72.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.00 / $102.00 / $151.97	Professional	TC	$62.00	$102.00	$151.97
United Facility/Professional Professional Modifier Low / Median / High Price $46.17 / $95.36 / $216.44	Professional		$46.17	$95.36	$216.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.34 / $32.85 / $79.34	Professional	26	$14.34	$32.85	$79.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.54 / $56.73 / $136.34	Professional	TC	$24.54	$56.73	$136.34