Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $149.41 / $477.02 / $882.00	Facility		$149.41	$477.02	$882.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.64 / $35.79 / $61.24	Facility	26	$26.64	$35.79	$61.24
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $113.62 / $401.97 / $883.84	Facility	TC	$113.62	$401.97	$883.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.00 / $69.56 / $187.06	Professional		$33.00	$69.56	$187.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.63 / $12.99 / $51.55	Professional	26	$7.63	$12.99	$51.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.37 / $39.36 / $138.47	Professional	TC	$25.37	$39.36	$138.47
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 $62.38 / $102.86 / $145.36	Professional		$62.38	$102.86	$145.36
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 $49.62 / $76.09 / $116.47	Professional	TC	$49.62	$76.09	$116.47
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $45.35 / $170.94 / $616.41	Facility		$45.35	$170.94	$616.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.50 / $120.33 / $252.45	Professional		$97.50	$120.33	$252.45
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 $75.81 / $96.06 / $226.72	Professional	TC	$75.81	$96.06	$226.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $128.75 / $167.40 / $243.62	Professional		$128.75	$167.40	$243.62
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 $97.50 / $133.65 / $187.74	Professional	TC	$97.50	$133.65	$187.74
Providence Facility/Professional Facility Modifier Low / Median / High Price $45.35 / $54.42 / $386.22	Facility		$45.35	$54.42	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.69 / $128.75 / $235.62	Professional		$53.69	$128.75	$235.62
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 $83.00 / $126.00 / $187.45	Professional	TC	$83.00	$126.00	$187.45
United Facility/Professional Professional Modifier Low / Median / High Price $42.90 / $105.68 / $230.23	Professional		$42.90	$105.68	$230.23
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 $30.96 / $84.20 / $162.85	Professional	TC	$30.96	$84.20	$162.85