Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $94.72 / $483.14 / $746.62	Facility		$94.72	$483.14	$746.62
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.76 / $34.63 / $58.32	Facility	26	$25.76	$34.63	$58.32
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $91.50 / $442.26 / $919.92	Facility	TC	$91.50	$442.26	$919.92
Aetna Facility/Professional Professional Modifier Low / Median / High Price $28.64 / $53.59 / $152.19	Professional		$28.64	$53.59	$152.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.33 / $12.40 / $59.86	Professional	26	$7.33	$12.40	$59.86
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $10.54 / $39.11 / $49.72	Professional	50	$10.54	$39.11	$49.72
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.45 / $50.45 / $72.73	Professional	52	$50.45	$50.45	$72.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $21.32 / $44.93 / $152.41	Professional	TC	$21.32	$44.93	$152.41
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 $51.46 / $86.73 / $122.44	Professional		$51.46	$86.73	$122.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $12.26 / $25.91 / $29.66	Professional	26	$12.26	$25.91	$29.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.20 / $60.81 / $94.76	Professional	TC	$39.20	$60.81	$94.76
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.65 / $144.29 / $673.26	Facility		$37.65	$144.29	$673.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $80.95 / $98.97 / $211.59	Professional		$80.95	$98.97	$211.59
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $19.39 / $23.72 / $69.36	Professional	26	$19.39	$23.72	$69.36
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $40.50 / $40.50 / $40.50	Professional	50	$40.50	$40.50	$40.50
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $58.31 / $75.69 / $152.90	Professional	TC	$58.31	$75.69	$152.90
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $110.00 / $139.05 / $205.62	Professional		$110.00	$139.05	$205.62
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.00 / $34.79 / $53.64	Professional	26	$30.00	$34.79	$53.64
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $80.00 / $106.65 / $151.97	Professional	TC	$80.00	$106.65	$151.97
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.65 / $45.18 / $386.22	Facility		$37.65	$45.18	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $44.44 / $110.00 / $197.54	Professional		$44.44	$110.00	$197.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.00 / $36.00 / $54.48	Professional	26	$24.00	$36.00	$54.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $66.00 / $102.00 / $151.97	Professional	TC	$66.00	$102.00	$151.97
United Facility/Professional Professional Modifier Low / Median / High Price $42.90 / $88.49 / $194.87	Professional		$42.90	$88.49	$194.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $11.94 / $29.65 / $65.18	Professional	26	$11.94	$29.65	$65.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $30.96 / $56.73 / $129.69	Professional	TC	$30.96	$56.73	$129.69