Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $118.71 / $457.66 / $810.70	Facility		$118.71	$457.66	$810.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.86 / $34.21 / $81.93	Facility	26	$24.86	$34.21	$81.93
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $84.51 / $233.60 / $458.38	Facility	TC	$84.51	$233.60	$458.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.46 / $32.42 / $118.71	Professional		$26.46	$32.42	$118.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $11.89 / $40.90	Professional	26	$7.63	$11.89	$40.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $23.48 / $102.64	Professional	TC	$18.82	$23.48	$102.64
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 $48.49 / $79.93 / $112.84	Professional		$48.49	$79.93	$112.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $26.52 / $29.31	Professional	26	$11.77	$26.52	$29.31
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 $35.42 / $35.42 / $135.81	Facility		$35.42	$35.42	$135.81
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.63 / $93.15 / $197.18	Professional		$77.63	$93.15	$197.18
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.60 / $22.61 / $66.17	Professional	26	$18.60	$22.61	$66.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.55 / $70.83 / $166.92	Professional	TC	$54.55	$70.83	$166.92
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.25 / $129.60 / $196.68	Professional		$106.25	$129.60	$196.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.75 / $31.20 / $53.64	Professional	26	$28.75	$31.20	$53.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $76.25 / $98.55 / $143.04	Professional	TC	$76.25	$98.55	$143.04
Providence Facility/Professional Facility Modifier Low / Median / High Price $35.42 / $42.50 / $386.22	Facility		$35.42	$42.50	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $41.39 / $106.25 / $190.35	Professional		$41.39	$106.25	$190.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $36.00 / $53.64	Professional	26	$25.00	$36.00	$53.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.00 / $96.00 / $143.04	Professional	TC	$58.00	$96.00	$143.04
United Facility/Professional Professional Modifier Low / Median / High Price $42.45 / $83.34 / $187.94	Professional		$42.45	$83.34	$187.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.66 / $24.40 / $58.93	Professional	26	$8.66	$24.40	$58.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.10 / $53.38 / $127.49	Professional	TC	$23.10	$53.38	$127.49