Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $264.69 / $288.92 / $1,240.55	Facility		$264.69	$288.92	$1,240.55
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.60 / $104.60 / $104.60	Facility	26	$104.60	$104.60	$104.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.21 / $262.35 / $370.70	Professional		$204.21	$262.35	$370.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.90 / $48.22 / $104.59	Professional	26	$33.90	$48.22	$104.59
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $169.96 / $214.14 / $306.48	Professional	TC	$169.96	$214.14	$306.48
Cigna Facility/Professional Facility Modifier Low / Median / High Price $1,060.27 / $1,060.27 / $1,060.27	Facility		$1,060.27	$1,060.27	$1,060.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.00 / $276.02 / $559.66	Professional		$177.00	$276.02	$559.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.64 / $61.76 / $136.84	Professional	26	$37.64	$61.76	$136.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.63 / $229.38 / $422.83	Professional	TC	$138.63	$229.38	$422.83
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $196.59 / $353.05 / $494.27	Facility		$196.59	$353.05	$494.27
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $422.67 / $522.05 / $1,011.97	Professional		$422.67	$522.05	$1,011.97
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $92.20 / $110.64 / $247.55	Professional	26	$92.20	$110.64	$247.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $339.89 / $411.45 / $764.42	Professional	TC	$339.89	$411.45	$764.42
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $591.84 / $730.35 / $984.54	Professional		$591.84	$730.35	$984.54
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $103.74 / $151.19 / $208.32	Professional	26	$103.74	$151.19	$208.32
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $469.80 / $583.20 / $775.92	Professional	TC	$469.80	$583.20	$775.92
Providence Facility/Professional Facility Modifier Low / Median / High Price $196.59 / $353.05 / $504.86	Facility		$196.59	$353.05	$504.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $244.45 / $530.17 / $959.00	Professional		$244.45	$530.17	$959.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.72 / $168.00 / $215.49	Professional	26	$71.72	$168.00	$215.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $232.82 / $626.40 / $808.08	Professional	TC	$232.82	$626.40	$808.08
United Facility/Professional Professional Modifier Low / Median / High Price $318.79 / $447.74 / $895.48	Professional		$318.79	$447.74	$895.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.01 / $109.46 / $218.92	Professional	26	$46.01	$109.46	$218.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $284.99 / $338.28 / $640.25	Professional	TC	$284.99	$338.28	$640.25