Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $21.99 / $247.50 / $2,353.19	Facility		$21.99	$247.50	$2,353.19
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $101.63	Facility	26	$43.24	$43.24	$101.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.91 / $45.61 / $118.45	Professional		$30.91	$45.61	$118.45
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.00 / $19.09 / $119.05	Professional	26	$13.00	$19.09	$119.05
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $30.60 / $70.81	Professional	TC	$17.89	$30.60	$70.81
Cigna Facility/Professional Professional Modifier Low / Median / High Price $34.71 / $58.30 / $113.41	Professional		$34.71	$58.30	$113.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.67 / $26.25 / $50.87	Professional	26	$16.67	$26.25	$50.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $18.66 / $34.47 / $62.54	Professional	TC	$18.66	$34.47	$62.54
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $43.80 / $118.45 / $165.83	Facility		$43.80	$118.45	$165.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.00 / $111.60 / $242.99	Professional		$93.00	$111.60	$242.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.35 / $41.67 / $99.83	Professional	26	$32.35	$41.67	$99.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.82 / $72.78 / $143.16	Professional	TC	$38.82	$72.78	$143.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $155.75 / $213.60	Professional		$120.00	$155.75	$213.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $60.00 / $91.64	Professional	26	$50.00	$60.00	$91.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $68.75 / $99.90 / $134.75	Professional	TC	$68.75	$99.90	$134.75
Providence Facility/Professional Facility Modifier Low / Median / High Price $43.80 / $118.45 / $165.83	Facility		$43.80	$118.45	$165.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $42.52 / $133.50 / $209.44	Professional		$42.52	$133.50	$209.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.31 / $61.50 / $97.58	Professional	26	$37.31	$61.50	$97.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $43.68 / $93.00 / $129.60	Professional	TC	$43.68	$93.00	$129.60
United Facility/Professional Professional Modifier Low / Median / High Price $47.06 / $113.40 / $192.78	Professional		$47.06	$113.40	$192.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.25 / $50.88 / $86.49	Professional	26	$21.25	$50.88	$86.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $29.18 / $62.73 / $106.29	Professional	TC	$29.18	$62.73	$106.29