Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $213.80 / $213.80 / $213.80	Facility		$213.80	$213.80	$213.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $54.95 / $60.26	Professional		$40.74	$54.95	$60.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.92 / $13.18 / $257.04	Professional	26	$6.92	$13.18	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $48.98 / $50.12	Professional	TC	$32.36	$48.98	$50.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $48.98 / $48.98	Professional		$48.98	$48.98	$48.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $9.12 / $9.12	Professional	26	$9.12	$9.12	$9.12
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 $33.11 / $69.18 / $213.80	Facility		$33.11	$69.18	$213.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $70.79 / $169.82	Professional		$22.91	$70.79	$169.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $5.25 / $19.05 / $281.84	Professional	26	$5.25	$19.05	$281.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $17.78 / $54.95 / $97.72	Professional	TC	$17.78	$54.95	$97.72
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $138.04 / $181.97	Professional		$39.81	$138.04	$181.97
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $30.20 / $36.31	Professional	26	$9.33	$30.20	$36.31
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $30.20 / $107.15 / $147.91	Professional	TC	$30.20	$107.15	$147.91
Providence Facility/Professional Facility Modifier Low / Median / High Price $22.91 / $33.11 / $72.44	Facility		$22.91	$33.11	$72.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $48.98 / $48.98	Professional		$48.98	$48.98	$48.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $9.12 / $9.12	Professional	26	$9.12	$9.12	$9.12
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 $31.62 / $72.44 / $109.65	Professional		$31.62	$72.44	$109.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $7.24 / $19.50 / $28.84	Professional	26	$7.24	$19.50	$28.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $53.70 / $81.28	Professional	TC	$23.99	$53.70	$81.28