Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.01 / $358.80 / $869.25	Facility		$97.01	$358.80	$869.25
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.46 / $34.21 / $62.63	Facility	26	$25.46	$34.21	$62.63
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $72.26 / $252.95 / $371.10	Facility	TC	$72.26	$252.95	$371.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.73 / $56.84 / $142.66	Professional		$27.73	$56.84	$142.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.66 / $10.47 / $36.11	Professional	26	$7.66	$10.47	$36.11
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $49.82 / $49.82 / $71.33	Professional	52	$49.82	$49.82	$71.33
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.07 / $25.03 / $90.33	Professional	TC	$20.07	$25.03	$90.33
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 $50.97 / $87.43 / $120.07	Professional		$50.97	$87.43	$120.07
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.27 / $27.47 / $29.31	Professional	26	$12.27	$27.47	$29.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $38.70 / $59.96 / $92.35	Professional	TC	$38.70	$59.96	$92.35
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.17 / $44.60 / $514.10	Facility		$37.17	$44.60	$514.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $79.92 / $98.01 / $208.89	Professional		$79.92	$98.01	$208.89
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $23.40 / $68.45	Professional	26	$19.39	$23.40	$68.45
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.08 / $72.28 / $150.97	Professional	TC	$28.08	$72.28	$150.97
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.50 / $137.69 / $205.62	Professional		$112.50	$137.69	$205.62
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $34.79 / $53.64	Professional	26	$30.00	$34.79	$53.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $82.50 / $105.30 / $151.97	Professional	TC	$82.50	$105.30	$151.97
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.17 / $44.60 / $386.22	Facility		$37.17	$44.60	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.03 / $112.50 / $203.37	Professional		$44.03	$112.50	$203.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.00 / $36.00 / $54.48	Professional	26	$26.00	$36.00	$54.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.00 / $102.00 / $151.97	Professional	TC	$64.00	$102.00	$151.97
United Facility/Professional Professional Modifier Low / Median / High Price $39.59 / $97.50 / $196.08	Professional		$39.59	$97.50	$196.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.62 / $24.40 / $58.92	Professional	26	$10.62	$24.40	$58.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.69 / $68.20 / $137.16	Professional	TC	$28.69	$68.20	$137.16