Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $323.59 / $724.44	Facility		$97.72	$323.59	$724.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $38.90 / $75.86	Facility	26	$28.84	$38.90	$75.86
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $199.53 / $323.59 / $616.60	Facility	TC	$199.53	$323.59	$616.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $56.23 / $173.78	Professional		$26.92	$56.23	$173.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.80 / $53.70	Professional	26	$7.94	$13.80	$53.70
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $436.52 / $436.52 / $436.52	Professional	50	$436.52	$436.52	$436.52
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	52	$151.36	$151.36	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.88 / $38.90 / $102.33	Professional	TC	$21.88	$38.90	$102.33
Cigna Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $389.05 / $389.05	Facility		$389.05	$389.05	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $102.33 / $147.91	Professional		$85.11	$102.33	$147.91
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $17.38 / $30.20 / $33.11	Professional	26	$17.38	$30.20	$33.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $83.18 / $117.49	Professional	TC	$72.44	$83.18	$117.49
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $48.98 / $213.80 / $691.83	Facility		$48.98	$213.80	$691.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $30.90 / $50.12 / $75.86	Facility	26	$30.90	$50.12	$75.86
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $87.10 / $478.63 / $794.33	Facility	TC	$87.10	$478.63	$794.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $107.15 / $173.78	Professional		$37.15	$107.15	$173.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $28.18 / $64.57	Professional	26	$10.96	$28.18	$64.57
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $25.70 / $204.17 / $436.52	Professional	50	$25.70	$204.17	$436.52
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $151.36 / $151.36 / $151.36	Professional	52	$151.36	$151.36	$151.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $87.10 / $141.25	Professional	TC	$39.81	$87.10	$141.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $165.96 / $239.88	Professional		$131.83	$165.96	$239.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $36.31 / $60.26	Professional	26	$33.88	$36.31	$60.26
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $128.82 / $186.21	Professional	TC	$95.50	$128.82	$186.21
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $53.70 / $93.33	Facility		$33.11	$53.70	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $77.62 / $109.65	Professional		$37.15	$77.62	$109.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.76 / $17.38 / $33.11	Professional	26	$7.76	$17.38	$33.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.70 / $37.15 / $89.13	Professional	TC	$25.70	$37.15	$89.13
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $100.00 / $199.53	Professional		$85.11	$100.00	$199.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $27.54 / $66.07	Professional	26	$23.44	$27.54	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $74.13 / $144.54	Professional	TC	$58.88	$74.13	$144.54