Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $121.57 / $364.91 / $364.91	Facility		$121.57	$364.91	$364.91
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $82.86 / $82.86 / $82.86	Facility	26	$82.86	$82.86	$82.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $75.56 / $90.51 / $184.32	Professional		$75.56	$90.51	$184.32
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.17 / $40.25 / $87.11	Professional	26	$31.17	$40.25	$87.11
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $37.79 / $63.91 / $63.91	Professional	52	$37.79	$63.91	$63.91
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $35.32 / $59.03 / $82.55	Professional	TC	$35.32	$59.03	$82.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $70.53 / $106.73 / $195.32	Professional		$70.53	$106.73	$195.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.13 / $44.24 / $106.97	Professional	26	$30.13	$44.24	$106.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $26.29 / $69.44 / $114.82	Professional	TC	$26.29	$69.44	$114.82
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $56.31 / $127.81 / $182.77	Facility		$56.31	$127.81	$182.77
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $94.05 / $136.83 / $211.16	Professional		$94.05	$136.83	$211.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.98 / $86.37 / $213.13	Professional	26	$71.98	$86.37	$213.13
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $42.05 / $50.46 / $92.16	Professional	TC	$42.05	$50.46	$92.16
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $176.25 / $229.48 / $345.65	Professional		$176.25	$229.48	$345.65
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $96.12 / $120.15 / $155.75	Professional	26	$96.12	$120.15	$155.75
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $65.00 / $87.00 / $201.00	Professional	TC	$65.00	$87.00	$201.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $56.31 / $127.81 / $178.93	Facility		$56.31	$127.81	$178.93
Providence Facility/Professional Professional Modifier Low / Median / High Price $69.53 / $165.53 / $345.65	Professional		$69.53	$165.53	$345.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.29 / $111.25 / $199.76	Professional	26	$37.29	$111.25	$199.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $65.00 / $131.66 / $298.80	Professional	TC	$65.00	$131.66	$298.80
United Facility/Professional Professional Modifier Low / Median / High Price $97.66 / $156.26 / $234.39	Professional		$97.66	$156.26	$234.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.47 / $85.58 / $89.00	Professional	26	$41.47	$85.58	$89.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.81 / $70.68 / $107.46	Professional	TC	$43.81	$70.68	$107.46