Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.32 / $426.30 / $578.20	Facility		$95.32	$426.30	$578.20
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.46 / $34.21 / $121.50	Facility	26	$25.46	$34.21	$121.50
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $66.47 / $361.12 / $643.78	Facility	TC	$66.47	$361.12	$643.78
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.41 / $57.42 / $149.32	Professional		$27.41	$57.42	$149.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $12.48 / $63.80	Professional	26	$7.95	$12.48	$63.80
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $337.50 / $337.50 / $337.50	Professional	50	$337.50	$337.50	$337.50
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.29 / $50.29 / $72.04	Professional	52	$50.29	$50.29	$72.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $19.46 / $24.25 / $91.50	Professional	TC	$19.46	$24.25	$91.50
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 $51.47 / $85.23 / $121.28	Professional		$51.47	$85.23	$121.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.27 / $27.73 / $29.31	Professional	26	$12.27	$27.73	$29.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $56.57 / $93.55	Professional	TC	$39.20	$56.57	$93.55
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.52 / $54.87 / $1,019.77	Facility		$37.52	$54.87	$1,019.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $80.67 / $98.97 / $210.82	Professional		$80.67	$98.97	$210.82
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 $58.31 / $75.69 / $180.70	Professional	TC	$58.31	$75.69	$180.70
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $113.75 / $139.05 / $210.09	Professional		$113.75	$139.05	$210.09
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 $83.75 / $106.65 / $156.44	Professional	TC	$83.75	$106.65	$156.44
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.52 / $45.02 / $386.22	Facility		$37.52	$45.02	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.47 / $113.75 / $204.45	Professional		$44.47	$113.75	$204.45
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $27.00 / $36.00 / $54.48	Professional	26	$27.00	$36.00	$54.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $62.06 / $105.00 / $156.44	Professional	TC	$62.06	$105.00	$156.44
United Facility/Professional Professional Modifier Low / Median / High Price $42.34 / $99.50 / $200.10	Professional		$42.34	$99.50	$200.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.94 / $24.40 / $58.92	Professional	26	$11.94	$24.40	$58.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.40 / $70.20 / $141.18	Professional	TC	$30.40	$70.20	$141.18