Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $257.04 / $257.04 / $478.63	Facility		$257.04	$257.04	$478.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $79.43 / $117.49	Professional		$61.66	$79.43	$117.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $38.02 / $316.23	Professional	26	$25.12	$38.02	$316.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $40.74 / $50.12 / $74.13	Professional	TC	$40.74	$50.12	$74.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.02	Professional	26	$38.02	$38.02	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	TC	$39.81	$39.81	$39.81
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $54.95 / $109.65 / $478.63	Facility		$54.95	$109.65	$478.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $51.29 / $169.82 / $346.74	Professional		$51.29	$169.82	$346.74
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.20 / $61.66 / $489.78	Professional	26	$18.20	$61.66	$489.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $107.15 / $165.96	Professional	TC	$33.88	$107.15	$165.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $275.42 / $380.19	Professional		$104.71	$275.42	$380.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $97.72 / $120.23	Professional	26	$30.20	$97.72	$120.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $177.83 / $263.03	Professional	TC	$74.13	$177.83	$263.03
Providence Facility/Professional Facility Modifier Low / Median / High Price $46.77 / $54.95 / $109.65	Facility		$46.77	$54.95	$109.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $77.62 / $77.62	Professional		$77.62	$77.62	$77.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.02 / $38.02	Professional	26	$38.02	$38.02	$38.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $39.81 / $39.81	Professional	TC	$39.81	$39.81	$39.81
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $151.36 / $229.09	Professional		$63.10	$151.36	$229.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $64.57 / $95.50	Professional	26	$23.44	$64.57	$95.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $89.13 / $131.83	Professional	TC	$39.81	$89.13	$131.83