Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $275.42 / $380.19 / $912.01	Facility		$275.42	$380.19	$912.01
Aetna Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $112.20 / $208.93	Professional		$91.20	$112.20	$208.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $97.72 / $870.96	Professional	26	$38.90	$97.72	$870.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $56.23 / $72.44	Professional	TC	$42.66	$56.23	$72.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Professional		$117.49	$117.49	$117.49
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Professional	26	$51.29	$51.29	$51.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	TC	$66.07	$66.07	$66.07
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $100.00 / $275.42 / $912.01	Facility		$100.00	$275.42	$912.01
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $181.97 / $446.68	Professional		$57.54	$181.97	$446.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $102.33 / $870.96	Professional	26	$41.69	$102.33	$870.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $24.55 / $69.18 / $79.43	Professional	TC	$24.55	$69.18	$79.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $309.03 / $389.05	Professional		$93.33	$309.03	$389.05
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $199.53 / $288.40	Professional	26	$50.12	$199.53	$288.40
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $144.54 / $380.19	Professional	TC	$42.66	$144.54	$380.19
Providence Facility/Professional Facility Modifier Low / Median / High Price $52.48 / $100.00 / $165.96	Facility		$52.48	$100.00	$165.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $117.49 / $117.49	Professional		$117.49	$117.49	$117.49
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $51.29 / $51.29	Professional	26	$51.29	$51.29	$51.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $66.07 / $66.07	Professional	TC	$66.07	$66.07	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $177.83 / $269.15	Professional		$70.79	$177.83	$269.15
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $107.15 / $162.18	Professional	26	$38.90	$107.15	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $70.79 / $107.15	Professional	TC	$32.36	$70.79	$107.15