Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $425.44 / $425.44 / $672.21	Facility		$425.44	$425.44	$672.21
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $251.06 / $251.06 / $251.06	Facility	26	$251.06	$251.06	$251.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $211.53 / $259.52 / $468.55	Professional		$211.53	$259.52	$468.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.86 / $56.99 / $276.49	Professional	26	$48.86	$56.99	$276.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $234.28 / $234.28 / $311.76	Professional	52	$234.28	$234.28	$311.76
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.66 / $192.06 / $202.54	Professional	TC	$162.66	$192.06	$202.54
Cigna Facility/Professional Facility Modifier Low / Median / High Price $13,806.02 / $13,806.02 / $13,806.02	Facility		$13,806.02	$13,806.02	$13,806.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $230.61 / $492.47 / $525.47	Professional		$230.61	$492.47	$525.47
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.96 / $170.98 / $298.38	Professional	26	$102.96	$170.98	$298.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.23 / $219.49 / $321.49	Professional	TC	$101.23	$219.49	$321.49
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $175.17 / $175.17 / $670.03	Facility		$175.17	$175.17	$670.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $359.05 / $437.93 / $986.10	Professional		$359.05	$437.93	$986.10
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $195.70 / $235.94 / $691.21	Professional	26	$195.70	$235.94	$691.21
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.68 / $196.02 / $474.18	Professional	TC	$154.68	$196.02	$474.18
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $555.00 / $614.90 / $1,034.81	Professional		$555.00	$614.90	$1,034.81
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $302.50 / $328.05 / $547.58	Professional	26	$302.50	$328.05	$547.58
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $252.50 / $312.00 / $487.23	Professional	TC	$252.50	$312.00	$487.23
Providence Facility/Professional Facility Modifier Low / Median / High Price $175.17 / $210.20 / $13,806.02	Facility		$175.17	$210.20	$13,806.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $218.72 / $540.00 / $1,026.04	Professional		$218.72	$540.00	$1,026.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $170.98 / $367.50 / $547.58	Professional	26	$170.98	$367.50	$547.58
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $248.40 / $327.00 / $487.23	Professional	TC	$248.40	$327.00	$487.23
United Facility/Professional Professional Modifier Low / Median / High Price $414.28 / $621.41 / $825.36	Professional		$414.28	$621.41	$825.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.42 / $248.35 / $440.00	Professional	26	$88.42	$248.35	$440.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $175.58 / $263.37 / $377.49	Professional	TC	$175.58	$263.37	$377.49