Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $91.82 / $335.16 / $812.70	Facility		$91.82	$335.16	$812.70
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.40 / $45.48 / $74.72	Facility	26	$33.40	$45.48	$74.72
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $68.05 / $325.50 / $745.89	Facility	TC	$68.05	$325.50	$745.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $27.58 / $37.31 / $112.65	Professional		$27.58	$37.31	$112.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $9.66 / $14.06 / $47.41	Professional	26	$9.66	$14.06	$47.41
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $17.92 / $28.32 / $91.50	Professional	TC	$17.92	$28.32	$91.50
Cigna Facility/Professional Facility Modifier Low / Median / High Price $386.22 / $386.22 / $386.22	Facility		$386.22	$386.22	$386.22
Cigna Facility/Professional Professional Modifier Low / Median / High Price $50.93 / $79.95 / $118.61	Professional		$50.93	$79.95	$118.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.70 / $33.58 / $38.44	Professional	26	$15.70	$33.58	$38.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.22 / $46.38 / $82.70	Professional	TC	$35.22	$46.38	$82.70
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $37.97 / $326.80 / $670.70	Facility		$37.97	$326.80	$670.70
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $81.66 / $98.01 / $211.48	Professional		$81.66	$98.01	$211.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $25.08 / $30.74 / $89.90	Professional	26	$25.08	$30.74	$89.90
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $52.29 / $67.92 / $160.03	Professional	TC	$52.29	$67.92	$160.03
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $111.25 / $136.35 / $205.62	Professional		$111.25	$136.35	$205.62
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.75 / $44.95 / $69.29	Professional	26	$38.75	$44.95	$69.29
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $72.50 / $94.50 / $136.34	Professional	TC	$72.50	$94.50	$136.34
Providence Facility/Professional Facility Modifier Low / Median / High Price $37.97 / $45.58 / $386.22	Facility		$37.97	$45.58	$386.22
Providence Facility/Professional Professional Modifier Low / Median / High Price $43.38 / $111.25 / $196.51	Professional		$43.38	$111.25	$196.51
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.00 / $46.50 / $70.37	Professional	26	$31.00	$46.50	$70.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.00 / $91.50 / $136.34	Professional	TC	$55.00	$91.50	$136.34
United Facility/Professional Professional Modifier Low / Median / High Price $46.57 / $82.86 / $200.20	Professional		$46.57	$82.86	$200.20
United Facility/Professional Professional Modifier 26 Low / Median / High Price $16.45 / $36.61 / $77.33	Professional	26	$16.45	$36.61	$77.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $31.11 / $52.69 / $120.83	Professional	TC	$31.11	$52.69	$120.83