Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.01 / $550.03 / $1,009.40	Facility		$97.01	$550.03	$1,009.40
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.15 / $37.38 / $88.20	Facility	26	$27.15	$37.38	$88.20
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $75.06 / $262.70 / $625.99	Facility	TC	$75.06	$262.70	$625.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.42 / $34.54 / $120.16	Professional		$29.42	$34.54	$120.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.46 / $9.89 / $37.38	Professional	26	$8.46	$9.89	$37.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.96 / $24.79 / $93.82	Professional	TC	$20.96	$24.79	$93.82
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 $53.94 / $82.83 / $124.81	Professional		$53.94	$82.83	$124.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.25 / $28.81 / $32.02	Professional	26	$13.25	$28.81	$32.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $40.69 / $54.02 / $94.76	Professional	TC	$40.69	$54.02	$94.76
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.84 / $39.54 / $743.99	Facility		$37.84	$39.54	$743.99
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $85.01 / $103.83 / $220.11	Professional		$85.01	$103.83	$220.11
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $22.54 / $27.33 / $74.81	Professional	26	$22.54	$27.33	$74.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.95 / $78.59 / $185.32	Professional	TC	$61.95	$78.59	$185.32
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.50 / $144.44 / $216.80	Professional		$117.50	$144.44	$216.80
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $32.50 / $37.70 / $58.11	Professional	26	$32.50	$37.70	$58.11
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.00 / $109.35 / $158.69	Professional	TC	$85.00	$109.35	$158.69
Providence Facility/Professional Facility Modifier Low / Median / High Price $39.54 / $47.45 / $386.22	Facility		$39.54	$47.45	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $46.16 / $117.50 / $212.51	Professional		$46.16	$117.50	$212.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $39.00 / $59.02	Professional	26	$27.00	$39.00	$59.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.00 / $106.50 / $158.69	Professional	TC	$64.00	$106.50	$158.69
United Facility/Professional Professional Modifier Low / Median / High Price $35.01 / $91.94 / $207.59	Professional		$35.01	$91.94	$207.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $14.33 / $32.03 / $64.40	Professional	26	$14.33	$32.03	$64.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $33.96 / $69.59 / $143.19	Professional	TC	$33.96	$69.59	$143.19