Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $134.36 / $861.00 / $1,498.42	Facility		$134.36	$861.00	$1,498.42
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.40 / $67.20 / $162.68	Facility	26	$59.40	$67.20	$162.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $134.36 / $447.53 / $1,043.41	Facility	TC	$134.36	$447.53	$1,043.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $96.15 / $172.21 / $438.00	Professional		$96.15	$172.21	$438.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.28 / $28.78 / $96.15	Professional	26	$23.28	$28.78	$96.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.95 / $145.09 / $225.24	Professional	TC	$106.95	$145.09	$225.24
Cigna Facility/Professional Facility Modifier Low / Median / High Price $466.44 / $466.44 / $466.44	Facility		$466.44	$466.44	$466.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $111.26 / $184.05 / $360.85	Professional		$111.26	$184.05	$360.85
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.69 / $31.87 / $77.81	Professional	26	$21.69	$31.87	$77.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.57 / $145.90 / $283.02	Professional	TC	$89.57	$145.90	$283.02
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $232.74 / $314.99 / $1,383.22	Facility		$232.74	$314.99	$1,383.22
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $277.54 / $343.53 / $484.09	Professional		$277.54	$343.53	$484.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.13 / $60.15 / $139.58	Professional	26	$50.13	$60.15	$139.58
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $236.13 / $283.35 / $525.71	Professional	TC	$236.13	$283.35	$525.71
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $352.00 / $481.95 / $639.84	Professional		$352.00	$481.95	$639.84
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $69.12 / $83.70 / $114.72	Professional	26	$69.12	$83.70	$114.72
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $281.60 / $398.25 / $522.66	Professional	TC	$281.60	$398.25	$522.66
Providence Facility/Professional Facility Modifier Low / Median / High Price $149.26 / $232.74 / $332.82	Facility		$149.26	$232.74	$332.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $134.78 / $350.84 / $613.04	Professional		$134.78	$350.84	$613.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $92.80 / $121.21	Professional	26	$40.47	$92.80	$121.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $163.21 / $404.55 / $540.64	Professional	TC	$163.21	$404.55	$540.64
United Facility/Professional Professional Modifier Low / Median / High Price $219.00 / $288.68 / $577.36	Professional		$219.00	$288.68	$577.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $30.78 / $62.26 / $124.52	Professional	26	$30.78	$62.26	$124.52
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.98 / $226.42 / $452.84	Professional	TC	$195.98	$226.42	$452.84