Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $303.83 / $515.16 / $519.86	Facility		$303.83	$515.16	$519.86
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.48 / $59.48 / $59.48	Facility	26	$59.48	$59.48	$59.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $184.55 / $196.07 / $303.83	Professional		$184.55	$196.07	$303.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.28 / $26.95 / $52.52	Professional	26	$23.28	$26.95	$52.52
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $92.28 / $124.23 / $223.61	Professional	52	$92.28	$124.23	$223.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $157.59 / $172.79 / $244.38	Professional	TC	$157.59	$172.79	$244.38
Cigna Facility/Professional Facility Modifier Low / Median / High Price $686.29 / $686.29 / $686.29	Facility		$686.29	$686.29	$686.29
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.39 / $209.96 / $389.88	Professional		$127.39	$209.96	$389.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.55 / $33.34 / $77.00	Professional	26	$21.55	$33.34	$77.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.83 / $169.67 / $312.88	Professional	TC	$105.83	$169.67	$312.88
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $140.85 / $248.46 / $347.84	Facility		$140.85	$248.46	$347.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $302.83 / $377.49 / $722.81	Professional		$302.83	$377.49	$722.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.95 / $61.14 / $140.74	Professional	26	$50.95	$61.14	$140.74
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $263.63 / $316.35 / $582.11	Professional	TC	$263.63	$316.35	$582.11
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $420.12 / $527.85 / $695.64	Professional		$420.12	$527.85	$695.64
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $68.04 / $86.40 / $115.29	Professional	26	$68.04	$86.40	$115.29
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $352.08 / $441.45 / $578.46	Professional	TC	$352.08	$441.45	$578.46
Providence Facility/Professional Facility Modifier Low / Median / High Price $153.29 / $248.46 / $355.30	Facility		$153.29	$248.46	$355.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $164.90 / $376.32 / $680.75	Professional		$164.90	$376.32	$680.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.29 / $92.80 / $121.21	Professional	26	$40.29	$92.80	$121.21
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $188.88 / $466.50 / $603.10	Professional	TC	$188.88	$466.50	$603.10
United Facility/Professional Professional Modifier Low / Median / High Price $265.83 / $311.89 / $623.79	Professional		$265.83	$311.89	$623.79
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.01 / $61.60 / $123.20	Professional	26	$22.01	$61.60	$123.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.02 / $261.60 / $473.73	Professional	TC	$217.02	$261.60	$473.73