Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $427.95 / $801.64 / $998.62	Facility		$427.95	$801.64	$998.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.79 / $113.96 / $182.57	Facility	26	$82.79	$113.96	$182.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $141.78 / $342.36	Professional		$67.84	$141.78	$342.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.78 / $47.68 / $216.20	Professional	26	$23.78	$47.68	$216.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $44.04 / $54.87 / $313.98	Professional	TC	$44.04	$54.87	$313.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $216.86 / $216.86 / $324.62	Professional		$216.86	$216.86	$324.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $85.57 / $85.57 / $97.06	Professional	26	$85.57	$85.57	$97.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.29 / $131.29 / $227.55	Professional	TC	$131.29	$131.29	$227.55
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $125.92 / $435.62 / $489.57	Facility		$125.92	$435.62	$489.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.75 / $381.92 / $844.68	Professional		$275.75	$381.92	$844.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.88 / $103.41 / $226.79	Professional	26	$63.88	$103.41	$226.79
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $211.88 / $274.35 / $617.89	Professional	TC	$211.88	$274.35	$617.89
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $426.25 / $494.45 / $681.68	Professional		$426.25	$494.45	$681.68
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $98.75 / $114.55 / $176.57	Professional	26	$98.75	$114.55	$176.57
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $327.50 / $363.15 / $505.11	Professional	TC	$327.50	$363.15	$505.11
Providence Facility/Professional Facility Modifier Low / Median / High Price $125.92 / $342.36 / $489.57	Facility		$125.92	$342.36	$489.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $135.85 / $457.50 / $635.46	Professional		$135.85	$457.50	$635.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $98.75 / $130.40 / $190.40	Professional	26	$98.75	$130.40	$190.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $324.00 / $360.00 / $505.11	Professional	TC	$324.00	$360.00	$505.11
United Facility/Professional Professional Modifier Low / Median / High Price $228.14 / $259.70 / $1,098.00	Professional		$228.14	$259.70	$1,098.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $68.73 / $78.06 / $376.00	Professional	26	$68.73	$78.06	$376.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.08 / $182.06 / $722.00	Professional	TC	$150.08	$182.06	$722.00