Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.90 / $445.90 / $680.12	Facility		$95.90	$445.90	$680.12
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.46 / $34.21 / $57.42	Facility	26	$25.46	$34.21	$57.42
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $68.54 / $262.92 / $456.86	Facility	TC	$68.54	$262.92	$456.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $25.55 / $39.17 / $119.88	Professional		$25.55	$39.17	$119.88
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.03 / $11.89 / $47.79	Professional	26	$7.03	$11.89	$47.79
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $47.96 / $47.96 / $67.75	Professional	52	$47.96	$47.96	$67.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.53 / $23.10 / $68.54	Professional	TC	$18.53	$23.10	$68.54
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 $48.49 / $79.59 / $114.04	Professional		$48.49	$79.59	$114.04
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.77 / $25.57 / $29.31	Professional	26	$11.77	$25.57	$29.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $36.72 / $54.02 / $87.52	Professional	TC	$36.72	$54.02	$87.52
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $35.42 / $35.42 / $137.15	Facility		$35.42	$35.42	$137.15
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $77.63 / $93.15 / $199.16	Professional		$77.63	$93.15	$199.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $18.60 / $22.61 / $66.17	Professional	26	$18.60	$22.61	$66.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.55 / $70.83 / $169.20	Professional	TC	$54.55	$70.83	$169.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $108.75 / $130.94 / $198.92	Professional		$108.75	$130.94	$198.92
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.75 / $31.20 / $53.64	Professional	26	$28.75	$31.20	$53.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $78.75 / $99.90 / $145.28	Professional	TC	$78.75	$99.90	$145.28
Providence Facility/Professional Facility Modifier Low / Median / High Price $35.42 / $42.50 / $386.22	Facility		$35.42	$42.50	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $41.83 / $108.75 / $197.40	Professional		$41.83	$108.75	$197.40
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $36.00 / $53.64	Professional	26	$24.00	$36.00	$53.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $59.10 / $97.50 / $145.28	Professional	TC	$59.10	$97.50	$145.28
United Facility/Professional Professional Modifier Low / Median / High Price $71.38 / $75.58 / $162.50	Professional		$71.38	$75.58	$162.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.90 / $23.44 / $58.93	Professional	26	$10.90	$23.44	$58.93
United Facility/Professional Professional Modifier TC Low / Median / High Price $28.69 / $52.14 / $112.10	Professional	TC	$28.69	$52.14	$112.10