Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.53 / $539.98 / $996.31	Facility		$121.53	$539.98	$996.31
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.30 / $41.72 / $58.98	Facility	26	$30.30	$41.72	$58.98
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $68.05 / $411.27 / $534.69	Facility	TC	$68.05	$411.27	$534.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.73 / $44.12 / $125.51	Professional		$30.73	$44.12	$125.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.73 / $12.69 / $44.06	Professional	26	$9.73	$12.69	$44.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.01 / $26.19 / $81.01	Professional	TC	$21.01	$26.19	$81.01
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 $49.95 / $93.54 / $116.28	Professional		$49.95	$93.54	$116.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.72 / $33.59 / $35.72	Professional	26	$14.72	$33.59	$35.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.22 / $59.12 / $82.70	Professional	TC	$35.22	$59.12	$82.70
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.01 / $37.01 / $140.41	Facility		$37.01	$37.01	$140.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $79.56 / $96.06 / $206.09	Professional		$79.56	$96.06	$206.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $23.45 / $28.55 / $83.53	Professional	26	$23.45	$28.55	$83.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.50 / $67.92 / $160.03	Professional	TC	$53.50	$67.92	$160.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $133.65 / $216.00	Professional		$120.00	$133.65	$216.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.25 / $41.60 / $64.81	Professional	26	$36.25	$41.60	$64.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.00 / $94.50 / $134.55	Professional	TC	$80.00	$94.50	$134.55
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.01 / $44.41 / $466.44	Facility		$37.01	$44.41	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.60 / $118.80 / $198.92	Professional		$45.60	$118.80	$198.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $43.50 / $65.83	Professional	26	$32.00	$43.50	$65.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.06 / $90.00 / $146.24	Professional	TC	$62.06	$90.00	$146.24
United Facility/Professional Professional Modifier Low / Median / High Price $48.82 / $85.06 / $192.76	Professional		$48.82	$85.06	$192.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.88 / $35.72 / $71.84	Professional	26	$14.88	$35.72	$71.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.64 / $50.04 / $120.91	Professional	TC	$38.64	$50.04	$120.91