Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $108.17 / $513.85 / $749.70	Facility		$108.17	$513.85	$749.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.71 / $50.40 / $75.68	Facility	26	$28.71	$50.40	$75.68
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $92.52 / $478.80 / $808.79	Facility	TC	$92.52	$478.80	$808.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $33.00 / $66.00 / $174.44	Professional		$33.00	$66.00	$174.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.56 / $14.07 / $70.64	Professional	26	$8.56	$14.07	$70.64
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $435.00 / $435.00 / $435.00	Professional	50	$435.00	$435.00	$435.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $59.48 / $59.48 / $107.06	Professional	52	$59.48	$59.48	$107.06
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $52.22 / $135.61	Professional	TC	$24.44	$52.22	$135.61
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 $61.38 / $102.56 / $145.32	Professional		$61.38	$102.56	$145.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $13.74 / $29.86 / $33.03	Professional	26	$13.74	$29.86	$33.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $47.64 / $72.70 / $114.06	Professional	TC	$47.64	$72.70	$114.06
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $44.78 / $53.74 / $785.70	Facility		$44.78	$53.74	$785.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $96.28 / $118.38 / $289.08	Professional		$96.28	$118.38	$289.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.83 / $26.37 / $77.16	Professional	26	$21.83	$26.37	$77.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.73 / $92.19 / $219.83	Professional	TC	$72.73	$92.19	$219.83
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.25 / $166.05 / $245.85	Professional		$131.25	$166.05	$245.85
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $33.75 / $39.15 / $60.35	Professional	26	$33.75	$39.15	$60.35
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $97.50 / $129.60 / $185.25	Professional	TC	$97.50	$129.60	$185.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $44.78 / $53.74 / $386.22	Facility		$44.78	$53.74	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $53.22 / $131.25 / $235.77	Professional		$53.22	$131.25	$235.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.00 / $40.50 / $61.29	Professional	26	$29.00	$40.50	$61.29
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $78.00 / $124.50 / $185.00	Professional	TC	$78.00	$124.50	$185.00
United Facility/Professional Professional Modifier Low / Median / High Price $46.50 / $104.82 / $233.94	Professional		$46.50	$104.82	$233.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $12.41 / $27.50 / $66.42	Professional	26	$12.41	$27.50	$66.42
United Facility/Professional Professional Modifier TC Low / Median / High Price $35.02 / $66.64 / $162.85	Professional	TC	$35.02	$66.64	$162.85