Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.23 / $430.20 / $654.29	Facility		$108.23	$430.20	$654.29
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.86 / $34.21 / $69.06	Facility	26	$24.86	$34.21	$69.06
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $74.02 / $139.32 / $467.62	Facility	TC	$74.02	$139.32	$467.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.57 / $44.01 / $114.29	Professional		$25.57	$44.01	$114.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.74 / $9.13 / $32.86	Professional	26	$6.74	$9.13	$32.86
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.82 / $23.48 / $89.72	Professional	TC	$18.82	$23.48	$89.72
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 $44.52 / $78.40 / $103.19	Professional		$44.52	$78.40	$103.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.27 / $24.38 / $29.31	Professional	26	$12.27	$24.38	$29.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.25 / $54.02 / $75.45	Professional	TC	$32.25	$54.02	$75.45
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.61 / $39.14 / $639.23	Facility		$32.61	$39.14	$639.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $70.13 / $85.38 / $181.61	Professional		$70.13	$85.38	$181.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $23.40 / $68.45	Professional	26	$19.39	$23.40	$68.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $47.77 / $62.10 / $146.25	Professional	TC	$47.77	$62.10	$146.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.00 / $118.80 / $178.80	Professional		$95.00	$118.80	$178.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.75 / $32.40 / $53.64	Professional	26	$28.75	$32.40	$53.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.25 / $86.40 / $125.16	Professional	TC	$66.25	$86.40	$125.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $32.61 / $39.14 / $386.22	Facility		$32.61	$39.14	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.86 / $95.00 / $178.60	Professional		$37.86	$95.00	$178.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.00 / $36.00 / $53.64	Professional	26	$23.00	$36.00	$53.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.08 / $84.00 / $125.16	Professional	TC	$56.08	$84.00	$125.16
United Facility/Professional Professional Modifier Low / Median / High Price $40.81 / $71.06 / $171.70	Professional		$40.81	$71.06	$171.70
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.42 / $29.30 / $58.93	Professional	26	$10.42	$29.30	$58.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.39 / $56.08 / $112.77	Professional	TC	$30.39	$56.08	$112.77