Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.39 / $280.67 / $422.79	Facility		$121.39	$280.67	$422.79
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.61 / $64.61 / $64.61	Facility	26	$64.61	$64.61	$64.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $129.78 / $169.60 / $229.50	Professional		$129.78	$169.60	$229.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.55 / $29.56 / $64.61	Professional	26	$22.55	$29.56	$64.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $106.95 / $140.04 / $185.49	Professional	TC	$106.95	$140.04	$185.49
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 $110.85 / $184.85 / $358.91	Professional		$110.85	$184.85	$358.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.85 / $36.27 / $85.37	Professional	26	$23.85	$36.27	$85.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $87.00 / $159.80 / $273.54	Professional	TC	$87.00	$159.80	$273.54
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $127.70 / $229.50 / $321.30	Facility		$127.70	$229.50	$321.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $274.56 / $338.67 / $660.94	Professional		$274.56	$338.67	$660.94
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $55.80 / $66.95 / $154.93	Professional	26	$55.80	$66.95	$154.93
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $226.43 / $271.70 / $506.06	Professional	TC	$226.43	$271.70	$506.06
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $373.68 / $477.90 / $636.12	Professional		$373.68	$477.90	$636.12
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $67.09 / $94.50 / $126.27	Professional	26	$67.09	$94.50	$126.27
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $297.00 / $383.40 / $505.92	Professional	TC	$297.00	$383.40	$505.92
Providence Facility/Professional Facility Modifier Low / Median / High Price $139.49 / $229.50 / $328.19	Facility		$139.49	$229.50	$328.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $159.66 / $345.94 / $609.45	Professional		$159.66	$345.94	$609.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.63 / $102.00 / $134.68	Professional	26	$44.63	$102.00	$134.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $161.90 / $408.00 / $523.33	Professional	TC	$161.90	$408.00	$523.33
United Facility/Professional Professional Modifier Low / Median / High Price $224.36 / $287.12 / $574.24	Professional		$224.36	$287.12	$574.24
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.04 / $68.30 / $129.27	Professional	26	$32.04	$68.30	$129.27
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.65 / $218.82 / $414.15	Professional	TC	$188.65	$218.82	$414.15