Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $512.86 / $512.86 / $512.86	Facility		$512.86	$512.86	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $144.54 / $251.19	Professional		$102.33	$144.54	$251.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.89 / $22.91 / $51.29	Professional	26	$20.89	$22.91	$51.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $117.49 / $194.98	Professional	TC	$81.28	$117.49	$194.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $457.09	Professional		$131.83	$223.87	$457.09
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $31.62 / $77.62	Professional	26	$21.88	$31.62	$77.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $194.98 / $389.05	Professional	TC	$112.20	$194.98	$389.05
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $131.83 / $190.55 / $389.05	Facility		$131.83	$190.55	$389.05
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $426.58 / $776.25	Professional		$331.13	$426.58	$776.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $69.18 / $144.54	Professional	26	$51.29	$69.18	$144.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $346.74 / $630.96	Professional	TC	$275.42	$346.74	$630.96
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $588.84 / $912.01	Professional		$407.38	$588.84	$912.01
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $93.33 / $138.04	Professional	26	$43.65	$93.33	$138.04
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $501.19 / $776.25	Professional	TC	$346.74	$501.19	$776.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $134.90 / $208.93 / $380.19	Facility		$134.90	$208.93	$380.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $223.87 / $457.09	Professional		$141.25	$223.87	$457.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $28.84 / $77.62	Professional	26	$21.88	$28.84	$77.62
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $162.18 / $389.05	Professional	TC	$112.20	$162.18	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $363.08 / $870.96	Professional		$138.04	$363.08	$870.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $67.61 / $181.97	Professional	26	$22.39	$67.61	$181.97
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $295.12 / $707.95	Professional	TC	$114.82	$295.12	$707.95