Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.00 / $453.01 / $653.66	Facility		$104.00	$453.01	$653.66
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.64 / $35.79 / $61.60	Facility	26	$26.64	$35.79	$61.60
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $57.29 / $344.65 / $470.62	Facility	TC	$57.29	$344.65	$470.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.30 / $29.78 / $104.00	Professional		$24.30	$29.78	$104.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $10.89 / $35.79	Professional	26	$7.95	$10.89	$35.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.35 / $20.38 / $68.20	Professional	TC	$16.35	$20.38	$68.20
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 $42.53 / $79.29 / $98.32	Professional		$42.53	$79.29	$98.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $27.81 / $30.66	Professional	26	$12.76	$27.81	$30.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $29.77 / $51.47 / $69.43	Professional	TC	$29.77	$51.47	$69.43
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $31.36 / $37.63 / $616.41	Facility		$31.36	$37.63	$616.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $67.42 / $81.51 / $174.63	Professional		$67.42	$81.51	$174.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $24.50 / $71.63	Professional	26	$20.23	$24.50	$71.63
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.03 / $57.24 / $134.68	Professional	TC	$45.03	$57.24	$134.68
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $120.90 / $202.50	Professional		$105.00	$120.90	$202.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.25 / $36.25 / $55.88	Professional	26	$31.25	$36.25	$55.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $73.75 / $85.55 / $130.00	Professional	TC	$73.75	$85.55	$130.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.36 / $37.63 / $466.44	Facility		$31.36	$37.63	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $38.72 / $100.80 / $180.00	Professional		$38.72	$100.80	$180.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $37.50 / $56.75	Professional	26	$27.00	$37.50	$56.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.00 / $85.00 / $131.66	Professional	TC	$56.00	$85.00	$131.66
United Facility/Professional Professional Modifier Low / Median / High Price $38.20 / $85.73 / $172.40	Professional		$38.20	$85.73	$172.40
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.67 / $25.54 / $61.69	Professional	26	$11.67	$25.54	$61.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $26.53 / $51.98 / $110.71	Professional	TC	$26.53	$51.98	$110.71