Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $124.55 / $634.50 / $989.80	Facility		$124.55	$634.50	$989.80
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.71 / $120.73 / $167.37	Facility	26	$87.71	$120.73	$167.37
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $168.25 / $513.09 / $787.63	Facility	TC	$168.25	$513.09	$787.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.70 / $118.44 / $331.04	Professional		$96.70	$118.44	$331.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.26 / $37.97 / $145.00	Professional	26	$25.26	$37.97	$145.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $71.45 / $88.97 / $181.71	Professional	TC	$71.45	$88.97	$181.71
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 $102.71 / $143.51 / $294.14	Professional		$102.71	$143.51	$294.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.23 / $53.52 / $102.82	Professional	26	$22.23	$53.52	$102.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.93 / $94.89 / $204.31	Professional	TC	$70.93	$94.89	$204.31
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $168.77 / $364.95 / $725.71	Facility		$168.77	$364.95	$725.71
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $210.25 / $252.30 / $549.12	Professional		$210.25	$252.30	$549.12
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.13 / $80.55 / $185.03	Professional	26	$67.13	$80.55	$185.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $141.97 / $171.75 / $319.16	Professional	TC	$141.97	$171.75	$319.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $320.00 / $377.00 / $530.00	Professional		$320.00	$377.00	$530.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.75 / $120.35 / $168.00	Professional	26	$103.75	$120.35	$168.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $216.25 / $256.64 / $354.00	Professional	TC	$216.25	$256.64	$354.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $98.28 / $264.83 / $378.72	Facility		$98.28	$264.83	$378.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $121.60 / $277.92 / $522.00	Professional		$121.60	$277.92	$522.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.65 / $124.50 / $190.68	Professional	26	$54.65	$124.50	$190.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $124.25 / $261.00 / $404.45	Professional	TC	$124.25	$261.00	$404.45
United Facility/Professional Professional Modifier Low / Median / High Price $121.80 / $227.68 / $463.60	Professional		$121.80	$227.68	$463.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.79 / $102.83 / $171.52	Professional	26	$39.79	$102.83	$171.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.09 / $175.10 / $292.08	Professional	TC	$77.09	$175.10	$292.08