Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $228.43 / $999.30 / $2,227.54	Facility		$228.43	$999.30	$2,227.54
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $95.25 / $131.11 / $668.64	Facility	26	$95.25	$131.11	$668.64
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.31 / $182.75 / $416.00	Professional		$67.31	$182.75	$416.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.01 / $91.55 / $776.54	Professional	26	$29.01	$91.55	$776.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $33.42 / $109.00 / $187.42	Professional	TC	$33.42	$109.00	$187.42
Cigna Facility/Professional Professional Modifier Low / Median / High Price $86.71 / $122.83 / $201.93	Professional		$86.71	$122.83	$201.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.44 / $60.47 / $112.64	Professional	26	$36.44	$60.47	$112.64
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.49 / $56.76 / $147.58	Professional	TC	$39.49	$56.76	$147.58
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $182.75 / $185.45 / $368.12	Facility		$182.75	$185.45	$368.12
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $105.91 / $171.75 / $385.77	Professional		$105.91	$171.75	$385.77
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $87.33 / $150.30	Professional	26	$72.78	$87.33	$150.30
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $69.59 / $84.42 / $151.15	Professional	TC	$69.59	$84.42	$151.15
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $201.25 / $256.64 / $362.07	Professional		$201.25	$256.64	$362.07
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $112.50 / $130.50 / $184.00	Professional	26	$112.50	$130.50	$184.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $87.50 / $117.45 / $156.80	Professional	TC	$87.50	$117.45	$156.80
Providence Facility/Professional Facility Modifier Low / Median / High Price $137.03 / $182.75 / $261.33	Facility		$137.03	$182.75	$261.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.48 / $201.25 / $362.07	Professional		$79.48	$201.25	$362.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $135.00 / $204.30	Professional	26	$66.73	$135.00	$204.30
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.06 / $117.00 / $180.95	Professional	TC	$70.06	$117.00	$180.95
United Facility/Professional Professional Modifier Low / Median / High Price $147.88 / $192.15 / $308.33	Professional		$147.88	$192.15	$308.33
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.10 / $112.65 / $191.51	Professional	26	$45.10	$112.65	$191.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $57.76 / $87.13 / $164.52	Professional	TC	$57.76	$87.13	$164.52