Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $141.25 / $239.88 / $239.88	Facility	26	$141.25	$239.88	$239.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $181.97 / $524.81	Professional		$112.20	$181.97	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $47.86 / $147.91	Professional	26	$26.92	$47.86	$147.91
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $107.15 / $398.11 / $407.38	Professional	52	$107.15	$398.11	$407.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $112.20 / $371.54	Professional	TC	$79.43	$112.20	$371.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $354.81 / $467.74	Professional		$257.04	$354.81	$467.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $114.82 / $134.90	Professional	26	$69.18	$114.82	$134.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $281.84 / $346.74	Professional	TC	$239.88	$281.84	$346.74
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $125.89 / $218.78 / $251.19	Facility	26	$125.89	$218.78	$251.19
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $338.84 / $537.03	Professional		$169.82	$338.84	$537.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $104.71 / $204.17	Professional	26	$42.66	$104.71	$204.17
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $39.81 / $117.49 / $407.38	Professional	52	$39.81	$117.49	$407.38
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $245.47 / $346.74	Professional	TC	$114.82	$245.47	$346.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $478.63 / $512.86 / $870.96	Professional		$478.63	$512.86	$870.96
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $134.90 / $144.54 / $245.47	Professional	26	$134.90	$144.54	$245.47
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $346.74 / $371.54 / $616.60	Professional	TC	$346.74	$371.54	$616.60
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $269.15 / $354.81	Professional		$128.82	$269.15	$354.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $69.18 / $134.90	Professional	26	$30.90	$69.18	$134.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $131.83 / $281.84	Professional	TC	$85.11	$131.83	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $501.19	Professional		$331.13	$331.13	$501.19
United Facility/Professional Professional Modifier 26 Low / Median / High Price $93.33 / $107.15 / $162.18	Professional	26	$93.33	$107.15	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $234.42 / $338.84	Professional	TC	$223.87	$234.42	$338.84