Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $118.43 / $616.41 / $753.62	Facility		$118.43	$616.41	$753.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.28 / $46.06 / $79.16	Facility	26	$34.28	$46.06	$79.16
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $101.98 / $453.72 / $615.00	Facility	TC	$101.98	$453.72	$615.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $36.65 / $52.88 / $148.05	Professional		$36.65	$52.88	$148.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $16.66 / $60.43	Professional	26	$10.02	$16.66	$60.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $26.62 / $33.17 / $107.69	Professional	TC	$26.62	$33.17	$107.69
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 $59.86 / $98.84 / $141.53	Professional		$59.86	$98.84	$141.53
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 / $63.36 / $104.41	Professional	TC	$43.67	$63.36	$104.41
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $44.28 / $53.14 / $667.36	Facility		$44.28	$53.14	$667.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $95.20 / $115.47 / $260.01	Professional		$95.20	$115.47	$260.01
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 / $201.44	Professional	TC	$65.06	$84.42	$201.44
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.75 / $162.00 / $239.15	Professional		$128.75	$162.00	$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 / $118.80 / $167.63	Professional	TC	$88.75	$118.80	$167.63
Providence Facility/Professional Facility Modifier Low / Median / High Price $44.28 / $53.14 / $466.44	Facility		$44.28	$53.14	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $51.74 / $128.75 / $230.30	Professional		$51.74	$128.75	$230.30
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 / $167.63	Professional	TC	$69.00	$112.50	$167.63
United Facility/Professional Professional Modifier Low / Median / High Price $54.66 / $114.70 / $230.67	Professional		$54.66	$114.70	$230.67
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.89 / $31.56 / $79.34	Professional	26	$14.89	$31.56	$79.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.25 / $62.62 / $147.40	Professional	TC	$39.25	$62.62	$147.40