Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $87.54 / $434.14 / $553.58	Facility		$87.54	$434.14	$553.58
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.15 / $31.87 / $31.87	Facility	26	$23.15	$31.87	$31.87
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $58.28 / $255.69 / $439.20	Facility	TC	$58.28	$255.69	$439.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $24.62 / $47.57 / $133.02	Professional		$24.62	$47.57	$133.02
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.71 / $11.32 / $54.88	Professional	26	$6.71	$11.32	$54.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $41.90 / $41.90 / $66.52	Professional	52	$41.90	$41.90	$66.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.89 / $22.31 / $72.86	Professional	TC	$17.89	$22.31	$72.86
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 $43.03 / $76.19 / $99.57	Professional		$43.03	$76.19	$99.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.28 / $23.87 / $27.29	Professional	26	$11.28	$23.87	$27.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.75 / $52.32 / $74.25	Professional	TC	$31.75	$52.32	$74.25
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $31.57 / $37.88 / $481.18	Facility		$31.57	$37.88	$481.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $67.88 / $82.47 / $177.76	Professional		$67.88	$82.47	$177.76
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $17.80 / $21.83 / $63.83	Professional	26	$17.80	$21.83	$63.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $48.11 / $61.14 / $123.75	Professional	TC	$48.11	$61.14	$123.75
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.00 / $116.10 / $174.33	Professional		$95.00	$116.10	$174.33
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $27.50 / $31.90 / $49.17	Professional	26	$27.50	$31.90	$49.17
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $67.50 / $86.40 / $125.16	Professional	TC	$67.50	$86.40	$125.16
Providence Facility/Professional Facility Modifier Low / Median / High Price $31.57 / $37.88 / $386.22	Facility		$31.57	$37.88	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $36.97 / $95.00 / $171.55	Professional		$36.97	$95.00	$171.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $22.00 / $33.00 / $49.94	Professional	26	$22.00	$33.00	$49.94
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.00 / $84.00 / $125.16	Professional	TC	$56.00	$84.00	$125.16
United Facility/Professional Professional Modifier Low / Median / High Price $39.59 / $69.39 / $174.19	Professional		$39.59	$69.39	$174.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $10.90 / $22.73 / $60.01	Professional	26	$10.90	$22.73	$60.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $27.05 / $54.11 / $114.18	Professional	TC	$27.05	$54.11	$114.18