Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $97.72 / $323.59 / $616.60	Facility		$97.72	$323.59	$616.60
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $141.25 / $338.84	Facility	26	$104.71	$141.25	$338.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $104.71 / $371.54	Professional		$67.61	$104.71	$371.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.12 / $40.74 / $131.83	Professional	26	$25.12	$40.74	$131.83
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $138.04 / $537.03 / $1,122.02	Professional	50	$138.04	$537.03	$1,122.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $58.88 / $147.91	Professional	TC	$41.69	$58.88	$147.91
Cigna Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $389.05 / $389.05	Facility		$389.05	$389.05	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $169.82 / $269.15	Professional		$93.33	$169.82	$269.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $63.10 / $112.20	Professional	26	$38.02	$63.10	$112.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $39.81 / $93.33 / $151.36	Professional	TC	$39.81	$93.33	$151.36
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $85.11 / $309.03 / $630.96	Facility		$85.11	$309.03	$630.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.71 / $141.25 / $380.19	Facility	26	$104.71	$141.25	$380.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $239.88 / $371.54	Professional		$93.33	$239.88	$371.54
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $97.72 / $169.82	Professional	26	$42.66	$97.72	$169.82
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $54.95 / $199.53 / $870.96	Professional	50	$54.95	$199.53	$870.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $141.25 / $208.93	Professional	TC	$77.62	$141.25	$208.93
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $346.74 / $501.19	Professional		$309.03	$346.74	$501.19
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $120.23 / $134.90 / $194.98	Professional	26	$120.23	$134.90	$194.98
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $194.98 / $213.80 / $309.03	Professional	TC	$194.98	$213.80	$309.03
Providence Facility/Professional Facility Modifier Low / Median / High Price $70.79 / $109.65 / $257.04	Facility		$70.79	$109.65	$257.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $81.28 / $154.88 / $263.03	Professional		$81.28	$154.88	$263.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $45.71 / $120.23	Professional	26	$30.90	$45.71	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $70.79 / $165.96	Professional	TC	$50.12	$70.79	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $269.15 / $457.09	Professional		$91.20	$269.15	$457.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $120.23 / $204.17	Professional	26	$38.02	$120.23	$204.17
United Facility/Professional Professional Modifier TC Low / Median / High Price $54.95 / $154.88 / $257.04	Professional	TC	$54.95	$154.88	$257.04