Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $86.73 / $438.95 / $900.62	Facility		$86.73	$438.95	$900.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.32 / $35.79 / $71.84	Facility	26	$26.32	$35.79	$71.84
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $83.71 / $352.95 / $789.30	Facility	TC	$83.71	$352.95	$789.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.96 / $53.73 / $159.50	Professional		$28.96	$53.73	$159.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $14.67 / $59.86	Professional	26	$7.33	$14.67	$59.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $343.50 / $343.50 / $343.50	Professional	50	$343.50	$343.50	$343.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.64 / $34.27 / $123.15	Professional	TC	$21.64	$34.27	$123.15
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 $56.43 / $89.27 / $129.68	Professional		$56.43	$89.27	$129.68
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.76 / $26.76 / $30.66	Professional	26	$12.76	$26.76	$30.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $43.67 / $62.51 / $100.79	Professional	TC	$43.67	$62.51	$100.79
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $41.15 / $49.38 / $821.59	Facility		$41.15	$49.38	$821.59
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $84.42 / $108.69 / $229.13	Professional		$84.42	$108.69	$229.13
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $20.23 / $24.50 / $71.63	Professional	26	$20.23	$24.50	$71.63
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $219.35 / $219.35 / $219.35	Professional	50	$219.35	$219.35	$219.35
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $65.06 / $84.42 / $199.16	Professional	TC	$65.06	$84.42	$199.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.50 / $151.19 / $219.03	Professional		$117.50	$151.19	$219.03
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $31.25 / $36.25 / $55.88	Professional	26	$31.25	$36.25	$55.88
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $86.25 / $117.45 / $163.16	Professional	TC	$86.25	$117.45	$163.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $41.15 / $49.38 / $386.22	Facility		$41.15	$49.38	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $48.41 / $117.50 / $210.64	Professional		$48.41	$117.50	$210.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $25.00 / $37.50 / $56.75	Professional	26	$25.00	$37.50	$56.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.00 / $109.50 / $162.50	Professional	TC	$69.00	$109.50	$162.50
United Facility/Professional Professional Modifier Low / Median / High Price $42.98 / $95.36 / $208.95	Professional		$42.98	$95.36	$208.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.94 / $25.54 / $61.69	Professional	26	$11.94	$25.54	$61.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.96 / $73.22 / $142.94	Professional	TC	$30.96	$73.22	$142.94