Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $199.98 / $564.48 / $891.80	Facility		$199.98	$564.48	$891.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.99 / $33.03 / $58.59	Facility	26	$23.99	$33.03	$58.59
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $75.18 / $331.45 / $620.10	Facility	TC	$75.18	$331.45	$620.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.25 / $37.19 / $114.29	Professional		$25.25	$37.19	$114.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.89 / $55.21	Professional	26	$7.03	$11.89	$55.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.21 / $31.21 / $91.13	Professional	TC	$18.21	$31.21	$91.13
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 / $77.04 / $103.19	Professional		$44.52	$77.04	$103.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $25.57 / $29.31	Professional	26	$11.77	$25.57	$29.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $32.75 / $51.47 / $76.67	Professional	TC	$32.75	$51.47	$76.67
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $32.61 / $39.14 / $616.41	Facility		$32.61	$39.14	$616.41
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 $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 $48.53 / $63.09 / $148.53	Professional	TC	$48.53	$63.09	$148.53
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $98.75 / $118.80 / $181.04	Professional		$98.75	$118.80	$181.04
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 $68.75 / $87.75 / $124.80	Professional	TC	$68.75	$87.75	$124.80
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 / $98.75 / $169.20	Professional		$37.86	$98.75	$169.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $36.00 / $53.64	Professional	26	$24.00	$36.00	$53.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.00 / $85.50 / $123.68	Professional	TC	$56.00	$85.50	$123.68
United Facility/Professional Professional Modifier Low / Median / High Price $41.29 / $69.12 / $148.61	Professional		$41.29	$69.12	$148.61
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.88 / $29.30 / $58.93	Professional	26	$10.88	$29.30	$58.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.11 / $55.86 / $107.58	Professional	TC	$28.11	$55.86	$107.58