Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $95.45 / $95.45 / $125.45	Facility		$95.45	$95.45	$125.45
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.71 / $28.95 / $76.58	Facility	26	$28.71	$28.95	$76.58
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $37.19 / $357.22 / $357.22	Facility	TC	$37.19	$357.22	$357.22
Aetna Facility/Professional Professional Modifier Low / Median / High Price $60.28 / $82.77 / $141.93	Professional		$60.28	$82.77	$141.93
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.22 / $24.51 / $61.27	Professional	26	$24.22	$24.51	$61.27
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $50.18 / $50.18 / $76.39	Professional	52	$50.18	$50.18	$76.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $28.14 / $55.64 / $68.20	Professional	TC	$28.14	$55.64	$68.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $55.25 / $128.69 / $161.02	Professional		$55.25	$128.69	$161.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.34 / $54.37 / $74.90	Professional	26	$23.34	$54.37	$74.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $24.80 / $57.37 / $106.65	Professional	TC	$24.80	$57.37	$106.65
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $43.57 / $43.57 / $148.24	Facility		$43.57	$43.57	$148.24
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $88.95 / $106.74 / $244.53	Professional		$88.95	$106.74	$244.53
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.55 / $59.19 / $148.06	Professional	26	$47.55	$59.19	$148.06
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $37.36 / $47.55 / $114.01	Professional	TC	$37.36	$47.55	$114.01
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $137.50 / $163.50 / $265.32	Professional		$137.50	$163.50	$265.32
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $76.25 / $82.35 / $117.36	Professional	26	$76.25	$82.35	$117.36
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $61.25 / $71.05 / $160.00	Professional	TC	$61.25	$71.05	$160.00
Providence Facility/Professional Facility Modifier Low / Median / High Price $43.57 / $52.28 / $143.51	Facility		$43.57	$52.28	$143.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $54.24 / $138.75 / $259.20	Professional		$54.24	$138.75	$259.20
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.98 / $91.50 / $117.36	Professional	26	$66.98	$91.50	$117.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.80 / $99.00 / $185.00	Professional	TC	$58.80	$99.00	$185.00
United Facility/Professional Professional Modifier Low / Median / High Price $95.36 / $112.86 / $140.72	Professional		$95.36	$112.86	$140.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $29.72 / $59.92 / $62.35	Professional	26	$29.72	$59.92	$62.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.93 / $52.94 / $79.79	Professional	TC	$52.93	$52.94	$79.79