Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.32 / $475.09 / $927.08	Facility		$91.32	$475.09	$927.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.28 / $46.06 / $81.93	Facility	26	$34.28	$46.06	$81.93
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $126.44 / $477.25 / $803.90	Facility	TC	$126.44	$477.25	$803.90
Aetna Facility/Professional Professional Modifier Low / Median / High Price $37.60 / $52.86 / $183.00	Professional		$37.60	$52.86	$183.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.02 / $16.66 / $57.02	Professional	26	$10.02	$16.66	$57.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $27.55 / $32.56 / $133.53	Professional	TC	$27.55	$32.56	$133.53
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 $71.77 / $105.43 / $166.86	Professional		$71.77	$105.43	$166.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $34.43 / $39.45	Professional	26	$16.20	$34.43	$39.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.58 / $71.00 / $129.74	Professional	TC	$55.58	$71.00	$129.74
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $50.65 / $52.67 / $197.35	Facility		$50.65	$52.67	$197.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $92.17 / $138.78 / $293.20	Professional		$92.17	$138.78	$293.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.88 / $31.52 / $92.17	Professional	26	$25.88	$31.52	$92.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.03 / $107.70 / $254.35	Professional	TC	$85.03	$107.70	$254.35
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.25 / $193.05 / $283.85	Professional		$151.25	$193.05	$283.85
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $40.00 / $46.40 / $71.52	Professional	26	$40.00	$46.40	$71.52
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $111.25 / $149.85 / $212.33	Professional	TC	$111.25	$149.85	$212.33
Providence Facility/Professional Facility Modifier Low / Median / High Price $52.67 / $63.20 / $386.22	Facility		$52.67	$63.20	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $61.88 / $151.25 / $270.55	Professional		$61.88	$151.25	$270.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $32.00 / $48.00 / $72.64	Professional	26	$32.00	$48.00	$72.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.32 / $142.50 / $212.33	Professional	TC	$85.32	$142.50	$212.33
United Facility/Professional Professional Modifier Low / Median / High Price $63.62 / $121.14 / $271.24	Professional		$63.62	$121.14	$271.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.02 / $32.85 / $79.34	Professional	26	$16.02	$32.85	$79.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.57 / $93.66 / $187.22	Professional	TC	$44.57	$93.66	$187.22