Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $160.68 / $160.68 / $160.68	Facility		$160.68	$160.68	$160.68
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.75 / $50.75 / $50.75	Facility	26	$50.75	$50.75	$50.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $52.94 / $111.62 / $153.12	Professional		$52.94	$111.62	$153.12
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.83 / $18.39 / $41.50	Professional	26	$14.83	$18.39	$41.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.11 / $83.17 / $122.47	Professional	TC	$38.11	$83.17	$122.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.21 / $200.87 / $312.14	Professional		$154.21	$200.87	$312.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.02 / $48.55 / $65.11	Professional	26	$42.02	$48.55	$65.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.66 / $135.76 / $270.13	Professional	TC	$105.66	$135.76	$270.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $61.22 / $131.40 / $201.04	Facility		$61.22	$131.40	$201.04
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $122.11 / $192.15 / $257.81	Professional		$122.11	$192.15	$257.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.68 / $52.41 / $82.15	Professional	26	$43.68	$52.41	$82.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.93 / $139.74 / $175.70	Professional	TC	$107.93	$139.74	$175.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.00 / $267.30 / $378.30	Professional		$97.00	$267.30	$378.30
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $67.50 / $95.63	Professional	26	$27.00	$67.50	$95.63
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.00 / $194.40 / $322.00	Professional	TC	$70.00	$194.40	$322.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $61.22 / $131.40 / $201.04	Facility		$61.22	$131.40	$201.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.10 / $171.20 / $448.80	Professional		$89.10	$171.20	$448.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $65.11 / $123.39	Professional	26	$27.00	$65.11	$123.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $96.60 / $185.00 / $342.72	Professional	TC	$96.60	$185.00	$342.72
United Facility/Professional Professional Modifier Low / Median / High Price $160.69 / $170.13 / $321.39	Professional		$160.69	$170.13	$321.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.40 / $52.08 / $104.16	Professional	26	$46.40	$52.08	$104.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $108.62 / $123.73 / $217.24	Professional	TC	$108.62	$123.73	$217.24