Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $602.56 / $602.56 / $602.56	Facility		$602.56	$602.56	$602.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $151.36 / $295.12	Professional		$134.90	$151.36	$295.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $134.90 / $776.25	Professional	26	$63.10	$134.90	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $85.11 / $158.49	Professional	TC	$72.44	$85.11	$158.49
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $158.49	Professional		$158.49	$158.49	$158.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	26	$93.33	$93.33	$93.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $64.57 / $64.57	Professional	TC	$64.57	$64.57	$64.57
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $125.89 / $204.17 / $602.56	Facility		$125.89	$204.17	$602.56
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $426.58 / $691.83	Professional		$114.82	$426.58	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $190.55 / $933.25	Professional	26	$56.23	$190.55	$933.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $173.78 / $346.74	Professional	TC	$58.88	$173.78	$346.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $676.08 / $933.25	Professional		$194.98	$676.08	$933.25
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $95.50 / $309.03 / $371.54	Professional	26	$95.50	$309.03	$371.54
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $371.54 / $575.44	Professional	TC	$97.72	$371.54	$575.44
Providence Facility/Professional Facility Modifier Low / Median / High Price $114.82 / $125.89 / $218.78	Facility		$114.82	$125.89	$218.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $158.49	Professional		$158.49	$158.49	$158.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $93.33 / $93.33	Professional	26	$93.33	$93.33	$93.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $64.57 / $64.57	Professional	TC	$64.57	$64.57	$64.57
United Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $389.05 / $588.84	Professional		$158.49	$389.05	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.13 / $204.17 / $302.00	Professional	26	$74.13	$204.17	$302.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $186.21 / $281.84	Professional	TC	$83.18	$186.21	$281.84