Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.01 / $554.92 / $899.10	Facility		$97.01	$554.92	$899.10
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.28 / $46.06 / $85.43	Facility	26	$34.28	$46.06	$85.43
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $87.70 / $348.75 / $669.50	Facility	TC	$87.70	$348.75	$669.50
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.10 / $56.86 / $143.35	Professional		$35.10	$56.86	$143.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $16.66 / $48.64	Professional	26	$10.02	$16.66	$48.64
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.05 / $50.15 / $160.50	Professional	TC	$25.05	$50.15	$160.50
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 $59.86 / $97.99 / $140.32	Professional		$59.86	$97.99	$140.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $35.47 / $39.45	Professional	26	$16.20	$35.47	$39.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.67 / $62.51 / $103.20	Professional	TC	$43.67	$62.51	$103.20
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $44.28 / $62.20 / $835.17	Facility		$44.28	$62.20	$835.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $95.20 / $115.47 / $246.51	Professional		$95.20	$115.47	$246.51
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $31.52 / $92.17	Professional	26	$25.88	$31.52	$92.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.06 / $84.42 / $199.16	Professional	TC	$65.06	$84.42	$199.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.75 / $160.65 / $239.15	Professional		$128.75	$160.65	$239.15
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 $88.75 / $117.45 / $167.63	Professional	TC	$88.75	$117.45	$167.63
Providence Facility/Professional Facility Modifier Low / Median / High Price $44.28 / $53.14 / $386.22	Facility		$44.28	$53.14	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.31 / $128.75 / $223.72	Professional		$51.31	$128.75	$223.72
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.00 / $48.00 / $72.64	Professional	26	$34.00	$48.00	$72.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.00 / $112.50 / $166.20	Professional	TC	$69.00	$112.50	$166.20
United Facility/Professional Professional Modifier Low / Median / High Price $50.68 / $102.25 / $222.97	Professional		$50.68	$102.25	$222.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.32 / $32.85 / $79.34	Professional	26	$14.32	$32.85	$79.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $36.61 / $74.37 / $151.33	Professional	TC	$36.61	$74.37	$151.33