Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.01 / $514.50 / $888.78	Facility		$97.01	$514.50	$888.78
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.64 / $35.79 / $70.56	Facility	26	$26.64	$35.79	$70.56
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $99.47 / $407.27 / $739.80	Facility	TC	$99.47	$407.27	$739.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $29.09 / $43.54 / $155.51	Professional		$29.09	$43.54	$155.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $12.99 / $49.78	Professional	26	$7.33	$12.99	$49.78
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $54.18 / $54.18 / $77.75	Professional	52	$54.18	$54.18	$77.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.94 / $34.70 / $121.27	Professional	TC	$21.94	$34.70	$121.27
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 $54.94 / $91.82 / $130.88	Professional		$54.94	$91.82	$130.88
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 $42.18 / $65.06 / $101.99	Professional	TC	$42.18	$65.06	$101.99
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $40.10 / $58.89 / $641.90	Facility		$40.10	$58.89	$641.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $86.22 / $105.78 / $225.23	Professional		$86.22	$105.78	$225.23
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 TC Low / Median / High Price $64.28 / $81.51 / $194.55	Professional	TC	$64.28	$81.51	$194.55
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $117.50 / $148.50 / $219.03	Professional		$117.50	$148.50	$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 / $114.75 / $163.16	Professional	TC	$86.25	$114.75	$163.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $40.10 / $48.12 / $386.22	Facility		$40.10	$48.12	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $47.52 / $117.50 / $211.82	Professional		$47.52	$117.50	$211.82
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 $71.00 / $109.50 / $163.16	Professional	TC	$71.00	$109.50	$163.16
United Facility/Professional Professional Modifier Low / Median / High Price $42.90 / $95.36 / $208.12	Professional		$42.90	$95.36	$208.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.68 / $25.54 / $61.69	Professional	26	$11.68	$25.54	$61.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.96 / $73.22 / $140.74	Professional	TC	$30.96	$73.22	$140.74