Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.29 / $502.74 / $645.29	Facility		$120.29	$502.74	$645.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.99 / $35.79 / $65.70	Facility	26	$25.99	$35.79	$65.70
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $84.51 / $267.74 / $518.28	Facility	TC	$84.51	$267.74	$518.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $37.79 / $120.29	Professional		$26.46	$37.79	$120.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $9.52 / $35.79	Professional	26	$7.33	$9.52	$35.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $23.87 / $89.24	Professional	TC	$19.14	$23.87	$89.24
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 $49.48 / $79.93 / $115.21	Professional		$49.48	$79.93	$115.21
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $26.76 / $30.66	Professional	26	$12.76	$26.76	$30.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.72 / $53.17 / $86.31	Professional	TC	$36.72	$53.17	$86.31
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $36.25 / $36.25 / $137.62	Facility		$36.25	$36.25	$137.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.94 / $95.10 / $201.85	Professional		$77.94	$95.10	$201.85
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 $55.81 / $68.50 / $141.24	Professional	TC	$55.81	$68.50	$141.24
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.50 / $132.30 / $196.68	Professional		$107.50	$132.30	$196.68
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 $76.25 / $98.55 / $140.40	Professional	TC	$76.25	$98.55	$140.40
Providence Facility/Professional Facility Modifier Low / Median / High Price $36.25 / $43.50 / $386.22	Facility		$36.25	$43.50	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.24 / $107.50 / $187.45	Professional		$42.24	$107.50	$187.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $37.50 / $56.75	Professional	26	$25.00	$37.50	$56.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.00 / $94.50 / $139.13	Professional	TC	$58.00	$94.50	$139.13
United Facility/Professional Professional Modifier Low / Median / High Price $31.76 / $78.06 / $188.21	Professional		$31.76	$78.06	$188.21
United Facility/Professional Professional Modifier 26 Low / Median / High Price $9.02 / $25.54 / $61.69	Professional	26	$9.02	$25.54	$61.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.30 / $52.53 / $120.83	Professional	TC	$31.30	$52.53	$120.83