Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $327.69 / $871.71 / $1,380.82	Facility		$327.69	$871.71	$1,380.82
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.61 / $150.38 / $242.25	Facility	26	$39.61	$150.38	$242.25
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $217.76 / $744.01 / $917.09	Facility	TC	$217.76	$744.01	$917.09
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.64 / $172.29 / $409.62	Professional		$119.64	$172.29	$409.62
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.67 / $42.71 / $156.40	Professional	26	$31.67	$42.71	$156.40
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $67.67 / $163.85 / $230.79	Professional	52	$67.67	$163.85	$230.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.95 / $109.52 / $217.75	Professional	TC	$87.95	$109.52	$217.75
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 $128.86 / $178.02 / $360.98	Professional		$128.86	$178.02	$360.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.14 / $66.90 / $129.16	Professional	26	$28.14	$66.90	$129.16
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $88.93 / $114.83 / $247.62	Professional	TC	$88.93	$114.83	$247.62
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $224.45 / $327.70 / $468.61	Facility		$224.45	$327.70	$468.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $261.20 / $313.44 / $628.16	Professional		$261.20	$313.44	$628.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $84.10 / $100.92 / $233.92	Professional	26	$84.10	$100.92	$233.92
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.10 / $212.52 / $394.25	Professional	TC	$177.10	$212.52	$394.25
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $397.50 / $468.35 / $646.00	Professional		$397.50	$468.35	$646.00
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $130.00 / $150.80 / $210.00	Professional	26	$130.00	$150.80	$210.00
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $266.25 / $317.55 / $436.00	Professional	TC	$266.25	$317.55	$436.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $122.02 / $327.70 / $466.44	Facility		$122.02	$327.70	$466.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $151.05 / $345.63 / $638.00	Professional		$151.05	$345.63	$638.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.26 / $156.00 / $236.08	Professional	26	$68.26	$156.00	$236.08
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $152.65 / $322.50 / $498.13	Professional	TC	$152.65	$322.50	$498.13
United Facility/Professional Professional Modifier Low / Median / High Price $151.74 / $345.63 / $576.53	Professional		$151.74	$345.63	$576.53
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.35 / $129.18 / $215.48	Professional	26	$49.35	$129.18	$215.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.23 / $216.45 / $346.32	Professional	TC	$95.23	$216.45	$346.32