Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $440.55 / $867.00 / $1,617.85	Facility		$440.55	$867.00	$1,617.85
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.86 / $165.00 / $270.33	Facility	26	$119.86	$165.00	$270.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.62 / $149.96 / $440.55	Professional		$122.62	$149.96	$440.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $52.80 / $165.00	Professional	26	$34.67	$52.80	$165.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $109.52 / $264.52	Professional	TC	$87.95	$109.52	$264.52
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 $135.60 / $192.69 / $383.77	Professional		$135.60	$192.69	$383.77
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.79 / $73.34 / $142.87	Professional	26	$43.79	$73.34	$142.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.81 / $120.35 / $259.51	Professional	TC	$91.81	$120.35	$259.51
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $232.68 / $352.44 / $503.99	Facility		$232.68	$352.44	$503.99
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $187.60 / $335.76 / $605.50	Professional		$187.60	$335.76	$605.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.20 / $110.64 / $254.87	Professional	26	$92.20	$110.64	$254.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.60 / $225.12 / $420.26	Professional	TC	$187.60	$225.12	$420.26
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $428.75 / $503.15 / $698.00	Professional		$428.75	$503.15	$698.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $142.50 / $165.30 / $230.00	Professional	26	$142.50	$165.30	$230.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $285.00 / $336.40 / $468.00	Professional	TC	$285.00	$336.40	$468.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $131.01 / $352.44 / $493.42	Facility		$131.01	$352.44	$493.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.93 / $383.77 / $694.00	Professional		$162.93	$383.77	$694.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $81.65 / $174.00 / $259.26	Professional	26	$81.65	$174.00	$259.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $211.12 / $346.50 / $534.69	Professional	TC	$211.12	$346.50	$534.69
United Facility/Professional Professional Modifier Low / Median / High Price $163.08 / $450.57 / $626.32	Professional		$163.08	$450.57	$626.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.12 / $114.99 / $238.33	Professional	26	$54.12	$114.99	$238.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.51 / $233.00 / $387.99	Professional	TC	$101.51	$233.00	$387.99