Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $109.65 / $549.54 / $707.95	Facility		$109.65	$549.54	$707.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $30.20 / $31.62	Facility	26	$28.18	$30.20	$31.62
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $75.86 / $263.03 / $398.11	Facility	TC	$75.86	$263.03	$398.11
Aetna Facility/Professional Professional Modifier Low / Median / High Price $26.92 / $44.67 / $144.54	Professional		$26.92	$44.67	$144.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $12.02 / $36.31	Professional	26	$7.94	$12.02	$36.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $33.11 / $75.86	Professional	TC	$18.20	$33.11	$75.86
Cigna Facility/Professional Facility Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Facility		$467.74	$467.74	$467.74
Cigna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $104.71 / $131.83	Professional		$72.44	$104.71	$131.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.44 / $30.20 / $38.90	Professional	26	$23.44	$30.20	$38.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $70.79 / $102.33	Professional	TC	$64.57	$70.79	$102.33
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.15 / $67.61 / $562.34	Facility		$37.15	$67.61	$562.34
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $30.20 / $31.62	Facility	26	$30.20	$30.20	$31.62
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $75.86 / $263.03 / $398.11	Facility	TC	$75.86	$263.03	$398.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $95.50 / $151.36	Professional		$52.48	$95.50	$151.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.45 / $26.30 / $43.65	Professional	26	$14.45	$26.30	$43.65
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $72.44 / $102.33	Professional	TC	$38.90	$72.44	$102.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $144.54 / $234.42	Professional		$131.83	$144.54	$234.42
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $72.44	Professional	26	$35.48	$45.71	$72.44
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $109.65 / $158.49	Professional	TC	$85.11	$109.65	$158.49
Providence Facility/Professional Facility Modifier Low / Median / High Price $29.51 / $48.98 / $93.33	Facility		$29.51	$48.98	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $35.48 / $72.44 / $104.71	Professional		$35.48	$72.44	$104.71
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.41 / $23.44 / $38.90	Professional	26	$7.41	$23.44	$38.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $23.44 / $33.88 / $75.86	Professional	TC	$23.44	$33.88	$75.86
United Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $93.33 / $181.97	Professional		$85.11	$93.33	$181.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $34.67 / $70.79	Professional	26	$22.39	$34.67	$70.79
United Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $66.07 / $114.82	Professional	TC	$53.70	$66.07	$114.82