Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $152.71 / $513.09 / $723.24	Facility		$152.71	$513.09	$723.24
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.28 / $46.06 / $72.86	Facility	26	$34.28	$46.06	$72.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $89.58 / $453.72 / $605.92	Facility	TC	$89.58	$453.72	$605.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $35.95 / $42.13 / $152.71	Professional		$35.95	$42.13	$152.71
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $10.36 / $12.21 / $44.01	Professional	26	$10.36	$12.21	$44.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $25.57 / $30.22 / $106.63	Professional	TC	$25.57	$30.22	$106.63
Cigna Facility/Professional Facility Modifier Low / Median / High Price $466.44 / $466.44 / $466.44	Facility		$466.44	$466.44	$466.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $62.34 / $101.19 / $146.35	Professional		$62.34	$101.19	$146.35
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.20 / $35.28 / $39.45	Professional	26	$16.20	$35.28	$39.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.15 / $65.91 / $109.23	Professional	TC	$46.15	$65.91	$109.23
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $43.86 / $46.02 / $174.70	Facility		$43.86	$46.02	$174.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $74.40 / $120.33 / $256.25	Professional		$74.40	$120.33	$256.25
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 $68.81 / $89.28 / $210.60	Professional	TC	$68.81	$89.28	$210.60
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.00 / $167.40 / $250.32	Professional		$135.00	$167.40	$250.32
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 $95.00 / $124.20 / $178.80	Professional	TC	$95.00	$124.20	$178.80
Providence Facility/Professional Facility Modifier Low / Median / High Price $46.02 / $55.22 / $466.44	Facility		$46.02	$55.22	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.51 / $135.00 / $242.21	Professional		$53.51	$135.00	$242.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.00 / $48.00 / $72.64	Professional	26	$33.00	$48.00	$72.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $78.00 / $120.00 / $178.80	Professional	TC	$78.00	$120.00	$178.80
United Facility/Professional Professional Modifier Low / Median / High Price $58.90 / $106.54 / $240.78	Professional		$58.90	$106.54	$240.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.60 / $32.85 / $79.34	Professional	26	$16.60	$32.85	$79.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.18 / $80.28 / $161.44	Professional	TC	$44.18	$80.28	$161.44