Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $115.22 / $508.20 / $810.00	Facility		$115.22	$508.20	$810.00
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.86 / $34.21 / $77.40	Facility	26	$24.86	$34.21	$77.40
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.01 / $256.64 / $453.72	Facility	TC	$81.01	$256.64	$453.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.92 / $52.78 / $138.18	Professional		$24.92	$52.78	$138.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $9.15 / $34.21	Professional	26	$7.03	$9.15	$34.21
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $286.50 / $286.50 / $286.50	Professional	50	$286.50	$286.50	$286.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $46.09 / $46.09 / $82.96	Professional	52	$46.09	$46.09	$82.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $22.31 / $64.81	Professional	TC	$17.89	$22.31	$64.81
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 $47.50 / $76.19 / $110.43	Professional		$47.50	$76.19	$110.43
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.27 / $25.57 / $29.31	Professional	26	$12.27	$25.57	$29.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.22 / $50.62 / $82.70	Professional	TC	$35.22	$50.62	$82.70
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $34.72 / $34.72 / $131.82	Facility		$34.72	$34.72	$131.82
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.29 / $91.23 / $195.25	Professional		$52.29	$91.23	$195.25
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 $52.29 / $67.92 / $162.31	Professional	TC	$52.29	$67.92	$162.31
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.50 / $128.25 / $189.98	Professional		$102.50	$128.25	$189.98
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 $72.50 / $95.85 / $136.34	Professional	TC	$72.50	$95.85	$136.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $34.72 / $41.66 / $466.44	Facility		$34.72	$41.66	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $40.94 / $102.50 / $182.80	Professional		$40.94	$102.50	$182.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $36.00 / $54.48	Professional	26	$24.00	$36.00	$54.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.00 / $91.50 / $136.34	Professional	TC	$55.00	$91.50	$136.34
United Facility/Professional Professional Modifier Low / Median / High Price $38.20 / $80.75 / $181.85	Professional		$38.20	$80.75	$181.85
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 $27.58 / $60.14 / $122.93	Professional	TC	$27.58	$60.14	$122.93