Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $75.02 / $75.02 / $75.02	Facility		$75.02	$75.02	$75.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $70.48 / $88.33 / $163.66	Professional		$70.48	$88.33	$163.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $28.98 / $35.51 / $77.88	Professional	26	$28.98	$35.51	$77.88
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $35.25 / $44.17 / $81.84	Professional	52	$35.25	$44.17	$81.84
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $41.51 / $52.82 / $85.79	Professional	TC	$41.51	$52.82	$85.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.35 / $65.20 / $208.01	Professional		$50.35	$65.20	$208.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.98 / $26.91 / $101.25	Professional	26	$21.98	$26.91	$101.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $28.37 / $38.29 / $106.76	Professional	TC	$28.37	$38.29	$106.76
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $59.60 / $122.75 / $163.66	Facility		$59.60	$122.75	$163.66
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $103.75 / $183.39 / $217.65	Professional		$103.75	$183.39	$217.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.96 / $76.65 / $78.75	Professional	26	$48.96	$76.65	$78.75
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.77 / $103.18 / $106.74	Professional	TC	$54.77	$103.18	$106.74
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.00 / $127.40 / $256.50	Professional		$89.00	$127.40	$256.50
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.00 / $55.30 / $106.65	Professional	26	$39.00	$55.30	$106.65
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $50.73 / $72.09 / $149.85	Professional	TC	$50.73	$72.09	$149.85
Providence Facility/Professional Facility Modifier Low / Median / High Price $53.38 / $122.75 / $163.66	Facility		$53.38	$122.75	$163.66
Providence Facility/Professional Professional Modifier Low / Median / High Price $78.40 / $124.60 / $267.00	Professional		$78.40	$124.60	$267.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.20 / $54.60 / $117.00	Professional	26	$33.20	$54.60	$117.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $45.20 / $70.00 / $150.00	Professional	TC	$45.20	$70.00	$150.00
United Facility/Professional Professional Modifier Low / Median / High Price $58.68 / $156.76 / $182.01	Professional		$58.68	$156.76	$182.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.16 / $67.87 / $79.00	Professional	26	$25.16	$67.87	$79.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.56 / $80.36 / $103.01	Professional	TC	$32.56	$80.36	$103.01