Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $302.00 / $338.84 / $676.08	Facility		$302.00	$338.84	$676.08
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $141.25 / $204.17	Professional		$107.15	$141.25	$204.17
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $173.78 / $891.25	Professional	26	$28.18	$173.78	$891.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $107.15 / $138.04	Professional	TC	$83.18	$107.15	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Professional		$89.13	$89.13	$89.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	26	$36.31	$36.31	$36.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	TC	$52.48	$52.48	$52.48
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $131.83 / $676.08	Facility		$75.86	$131.83	$676.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $218.78 / $446.68	Professional		$89.13	$218.78	$446.68
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $173.78 / $812.83	Professional	26	$21.38	$173.78	$812.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $141.25 / $323.59	Professional	TC	$61.66	$141.25	$323.59
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $489.78 / $616.60	Professional		$125.89	$489.78	$616.60
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $114.82 / $141.25	Professional	26	$36.31	$114.82	$141.25
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $371.54 / $467.74	Professional	TC	$89.13	$371.54	$467.74
Providence Facility/Professional Facility Modifier Low / Median / High Price $75.86 / $81.28 / $131.83	Facility		$75.86	$81.28	$131.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.13 / $89.13 / $89.13	Professional		$89.13	$89.13	$89.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $36.31 / $36.31	Professional	26	$36.31	$36.31	$36.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $52.48 / $52.48	Professional	TC	$52.48	$52.48	$52.48
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $251.19 / $380.19	Professional		$107.15	$251.19	$380.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $75.86 / $114.82	Professional	26	$27.54	$75.86	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $177.83 / $263.03	Professional	TC	$79.43	$177.83	$263.03