Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $93.33 / $234.42 / $812.83	Facility		$93.33	$234.42	$812.83
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $44.67 / $74.13	Facility	26	$36.31	$44.67	$74.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $81.28 / $323.59 / $707.95	Facility	TC	$81.28	$323.59	$707.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $37.15 / $109.65	Professional		$23.99	$37.15	$109.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $14.13 / $42.66	Professional	26	$7.94	$14.13	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.85 / $27.54 / $70.79	Professional	TC	$15.85	$27.54	$70.79
Cigna Facility/Professional Facility Modifier Low / Median / High Price $389.05 / $389.05 / $389.05	Facility		$389.05	$389.05	$389.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $67.61 / $79.43 / $123.03	Professional		$67.61	$79.43	$123.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $20.42 / $33.88 / $38.02	Professional	26	$20.42	$33.88	$38.02
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $61.66 / $87.10	Professional	TC	$46.77	$61.66	$87.10
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $50.12 / $144.54 / $812.83	Facility		$50.12	$144.54	$812.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $36.31 / $46.77 / $75.86	Facility	26	$36.31	$46.77	$75.86
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $64.57 / $323.59 / $741.31	Facility	TC	$64.57	$323.59	$741.31
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $89.13 / $138.04	Professional		$37.15	$89.13	$138.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.96 / $30.20 / $58.88	Professional	26	$10.96	$30.20	$58.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $28.18 / $61.66 / $87.10	Professional	TC	$28.18	$61.66	$87.10
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $134.90 / $194.98	Professional		$112.20	$134.90	$194.98
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $41.69 / $69.18	Professional	26	$38.90	$41.69	$69.18
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $95.50 / $131.83	Professional	TC	$70.79	$95.50	$131.83
Providence Facility/Professional Facility Modifier Low / Median / High Price $27.54 / $39.81 / $89.13	Facility		$27.54	$39.81	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $66.07 / $89.13	Professional		$30.20	$66.07	$89.13
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $8.71 / $20.42 / $38.02	Professional	26	$8.71	$20.42	$38.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.50 / $27.54 / $64.57	Professional	TC	$19.50	$27.54	$64.57
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $85.11 / $169.82	Professional		$74.13	$85.11	$169.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $26.92 / $32.36 / $66.07	Professional	26	$26.92	$32.36	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $52.48 / $104.71	Professional	TC	$43.65	$52.48	$104.71