Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $315.00 / $826.98 / $1,207.35	Facility		$315.00	$826.98	$1,207.35
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.31 / $115.97 / $164.56	Facility	26	$86.31	$115.97	$164.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.34 / $152.77 / $411.32	Professional		$107.34	$152.77	$411.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.07 / $40.00 / $144.49	Professional	26	$24.07	$40.00	$144.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $70.72 / $164.53 / $238.48	Professional	52	$70.72	$164.53	$238.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.28 / $110.76 / $295.35	Professional	TC	$83.28	$110.76	$295.35
Cigna Facility/Professional Facility Modifier Low / Median / High Price $466.44 / $466.44 / $466.44	Facility		$466.44	$466.44	$466.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.88 / $179.03 / $347.50	Professional		$110.88	$179.03	$347.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.87 / $50.91 / $98.76	Professional	26	$29.87	$50.91	$98.76
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.01 / $128.12 / $248.74	Professional	TC	$81.01	$128.12	$248.74
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $165.06 / $329.06 / $818.68	Facility		$165.06	$329.06	$818.68
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $261.20 / $318.30 / $627.26	Professional		$261.20	$318.30	$627.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.70 / $77.64 / $177.61	Professional	26	$64.70	$77.64	$177.61
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $200.55 / $240.66 / $449.65	Professional	TC	$200.55	$240.66	$449.65
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $406.25 / $477.05 / $664.00	Professional		$406.25	$477.05	$664.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $100.00 / $116.00 / $160.00	Professional	26	$100.00	$116.00	$160.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $306.25 / $359.60 / $504.00	Professional	TC	$306.25	$359.60	$504.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $121.49 / $329.06 / $466.44	Facility		$121.49	$329.06	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $145.47 / $347.50 / $654.00	Professional		$145.47	$347.50	$654.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.09 / $120.00 / $182.80	Professional	26	$56.09	$120.00	$182.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $226.59 / $370.50 / $575.82	Professional	TC	$226.59	$370.50	$575.82
United Facility/Professional Professional Modifier Low / Median / High Price $121.86 / $347.50 / $590.75	Professional		$121.86	$347.50	$590.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.61 / $79.00 / $164.73	Professional	26	$36.61	$79.00	$164.73
United Facility/Professional Professional Modifier TC Low / Median / High Price $89.27 / $248.75 / $422.87	Professional	TC	$89.27	$248.75	$422.87