Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $137.47 / $247.23 / $272.02	Facility		$137.47	$247.23	$272.02
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.00 / $93.00 / $93.00	Facility	26	$93.00	$93.00	$93.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $57.32 / $99.22 / $170.13	Professional		$57.32	$99.22	$170.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.52 / $53.26 / $102.43	Professional	26	$34.52	$53.26	$102.43
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $22.80 / $45.95 / $73.95	Professional	TC	$22.80	$45.95	$73.95
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 $71.51 / $111.16 / $188.16	Professional		$71.51	$111.16	$188.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.72 / $94.30 / $108.66	Professional	26	$44.72	$94.30	$108.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.79 / $57.53 / $80.47	Professional	TC	$26.79	$57.53	$80.47
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $57.28 / $151.40 / $211.96	Facility		$57.28	$151.40	$211.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $115.65 / $138.78 / $294.57	Professional		$115.65	$138.78	$294.57
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $87.33 / $198.87	Professional	26	$72.78	$87.33	$198.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.85 / $51.42 / $95.75	Professional	TC	$42.85	$51.42	$95.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $178.75 / $250.25 / $372.75	Professional		$178.75	$250.25	$372.75
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.50 / $147.75 / $217.08	Professional	26	$112.50	$147.75	$217.08
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $66.25 / $96.99 / $159.25	Professional	TC	$66.25	$96.99	$159.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $97.54 / $151.40 / $216.50	Facility		$97.54	$151.40	$216.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $68.43 / $180.00 / $372.75	Professional		$68.43	$180.00	$372.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $106.50 / $146.69 / $244.00	Professional	26	$106.50	$146.69	$244.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.11 / $100.98 / $182.00	Professional	TC	$60.11	$100.98	$182.00
United Facility/Professional Professional Modifier Low / Median / High Price $95.63 / $186.16 / $286.92	Professional		$95.63	$186.16	$286.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.75 / $113.26 / $184.75	Professional	26	$48.75	$113.26	$184.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.72 / $72.53 / $109.35	Professional	TC	$38.72	$72.53	$109.35