Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.05 / $502.47 / $839.86	Facility		$93.05	$502.47	$839.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.83 / $56.85 / $72.67	Facility	26	$30.83	$56.85	$72.67
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $89.17 / $458.00 / $720.00	Facility	TC	$89.17	$458.00	$720.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.71 / $58.28 / $178.92	Professional		$27.71	$58.28	$178.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $17.35 / $71.98	Professional	26	$8.56	$17.35	$71.98
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $100.00 / $100.00 / $122.61	Professional	50	$100.00	$100.00	$122.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.14 / $40.93 / $108.95	Professional	TC	$19.14	$40.93	$108.95
Cigna Facility/Professional Facility Modifier Low / Median / High Price $386.22 / $386.22 / $386.22	Facility		$386.22	$386.22	$386.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $52.45 / $84.73 / $122.40	Professional		$52.45	$84.73	$122.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.74 / $29.86 / $33.03	Professional	26	$13.74	$29.86	$33.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.70 / $54.87 / $91.14	Professional	TC	$38.70	$54.87	$91.14
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $38.49 / $191.90 / $812.42	Facility		$38.49	$191.90	$812.42
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $84.10 / $100.92 / $255.58	Professional		$84.10	$100.92	$255.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.83 / $26.19 / $77.16	Professional	26	$21.83	$26.19	$77.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $57.56 / $74.73 / $178.43	Professional	TC	$57.56	$74.73	$178.43
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $106.25 / $141.75 / $207.86	Professional		$106.25	$141.75	$207.86
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $39.15 / $60.35	Professional	26	$33.75	$39.15	$60.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.50 / $105.30 / $147.51	Professional	TC	$72.50	$105.30	$147.51
Providence Facility/Professional Facility Modifier Low / Median / High Price $38.49 / $46.19 / $386.22	Facility		$38.49	$46.19	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $45.29 / $106.60 / $197.54	Professional		$45.29	$106.60	$197.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.00 / $40.50 / $61.29	Professional	26	$29.00	$40.50	$61.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.04 / $99.00 / $146.87	Professional	TC	$60.04	$99.00	$146.87
United Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $89.35 / $199.50	Professional		$42.98	$89.35	$199.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.21 / $27.50 / $66.42	Professional	26	$12.21	$27.50	$66.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.77 / $66.15 / $133.08	Professional	TC	$30.77	$66.15	$133.08