Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.29 / $515.48 / $763.20	Facility		$120.29	$515.48	$763.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.99 / $35.79 / $80.75	Facility	26	$25.99	$35.79	$80.75
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $84.51 / $322.62 / $581.90	Facility	TC	$84.51	$322.62	$581.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.93 / $45.55 / $136.87	Professional		$29.93	$45.55	$136.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $9.88 / $49.78	Professional	26	$7.33	$9.88	$49.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.51 / $29.29 / $89.24	Professional	TC	$23.51	$29.29	$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 / $91.82 / $115.21	Professional		$49.48	$91.82	$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 / $62.13 / $86.31	Professional	TC	$36.72	$62.13	$86.31
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $36.25 / $43.50 / $580.11	Facility		$36.25	$43.50	$580.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.94 / $95.10 / $215.65	Professional		$77.94	$95.10	$215.65
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 / $143.16	Professional	TC	$55.81	$68.50	$143.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $105.00 / $133.65 / $200.25	Professional		$105.00	$133.65	$200.25
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 / $99.90 / $140.40	Professional	TC	$73.75	$99.90	$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 $42.67 / $105.00 / $194.45	Professional		$42.67	$105.00	$194.45
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 $65.06 / $93.00 / $145.69	Professional	TC	$65.06	$93.00	$145.69
United Facility/Professional Professional Modifier Low / Median / High Price $47.23 / $77.23 / $186.63	Professional		$47.23	$77.23	$186.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.94 / $25.54 / $61.69	Professional	26	$11.94	$25.54	$61.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.54 / $74.55 / $124.94	Professional	TC	$35.54	$74.55	$124.94