Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $228.29 / $914.20 / $1,141.46	Facility		$228.29	$914.20	$1,141.46
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.69 / $48.69 / $48.69	Facility	26	$48.69	$48.69	$48.69
Aetna Facility/Professional Professional Modifier Low / Median / High Price $81.59 / $100.49 / $303.89	Professional		$81.59	$100.49	$303.89
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.19 / $16.54 / $53.63	Professional	26	$14.19	$16.54	$53.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.40 / $83.94 / $250.26	Professional	TC	$67.40	$83.94	$250.26
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,060.27 / $1,060.27 / $1,060.27	Facility		$1,060.27	$1,060.27	$1,060.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $151.60 / $227.25 / $381.08	Professional		$151.60	$227.25	$381.08
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.06 / $50.11 / $57.36	Professional	26	$23.06	$50.11	$57.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.54 / $177.14 / $328.76	Professional	TC	$128.54	$177.14	$328.76
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $110.45 / $132.54 / $1,033.04	Facility		$110.45	$132.54	$1,033.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $237.47 / $294.99 / $630.52	Professional		$237.47	$294.99	$630.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $37.20 / $45.90 / $134.22	Professional	26	$37.20	$45.90	$134.22
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $198.13 / $250.35 / $611.00	Professional	TC	$198.13	$250.35	$611.00
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $318.75 / $421.20 / $612.39	Professional		$318.75	$421.20	$612.39
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $57.50 / $62.10 / $102.81	Professional	26	$57.50	$62.10	$102.81
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $260.00 / $359.10 / $509.58	Professional	TC	$260.00	$359.10	$509.58
Providence Facility/Professional Facility Modifier Low / Median / High Price $110.45 / $132.54 / $1,060.27	Facility		$110.45	$132.54	$1,060.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $135.94 / $318.75 / $556.20	Professional		$135.94	$318.75	$556.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.30 / $69.00 / $102.81	Professional	26	$46.30	$69.00	$102.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $215.67 / $342.00 / $509.58	Professional	TC	$215.67	$342.00	$509.58
United Facility/Professional Professional Modifier Low / Median / High Price $116.86 / $270.63 / $537.90	Professional		$116.86	$270.63	$537.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.83 / $47.74 / $115.34	Professional	26	$22.83	$47.74	$115.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $94.03 / $223.95 / $410.57	Professional	TC	$94.03	$223.95	$410.57