Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $104.71 / $346.74 / $676.08	Facility		$104.71	$346.74	$676.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.84 / $35.48 / $61.66	Facility	26	$28.84	$35.48	$61.66
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $60.26 / $457.09 / $562.34	Facility	TC	$60.26	$457.09	$562.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $36.31 / $112.20	Professional		$23.99	$36.31	$112.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $33.88	Professional	26	$7.08	$10.96	$33.88
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.22 / $23.99 / $60.26	Professional	TC	$16.22	$23.99	$60.26
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 $57.54 / $79.43 / $102.33	Professional		$57.54	$79.43	$102.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $27.54 / $30.90	Professional	26	$16.22	$27.54	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $54.95 / $72.44	Professional	TC	$51.29	$54.95	$72.44
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $33.11 / $77.62 / $549.54	Facility		$33.11	$77.62	$549.54
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $35.48 / $61.66	Facility	26	$26.92	$35.48	$61.66
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $54.95 / $346.74 / $467.74	Facility	TC	$54.95	$346.74	$467.74
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $75.86 / $114.82	Professional		$40.74	$75.86	$114.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $25.12 / $44.67	Professional	26	$9.77	$25.12	$44.67
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $27.54 / $52.48 / $74.13	Professional	TC	$27.54	$52.48	$74.13
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $120.23 / $204.17	Professional		$104.71	$120.23	$204.17
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $33.88 / $56.23	Professional	26	$30.90	$33.88	$56.23
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $87.10 / $141.25	Professional	TC	$74.13	$87.10	$141.25
Providence Facility/Professional Facility Modifier Low / Median / High Price $22.91 / $38.90 / $77.62	Facility		$22.91	$38.90	$77.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $63.10 / $79.43	Professional		$30.90	$63.10	$79.43
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $16.22 / $30.90	Professional	26	$7.08	$16.22	$30.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $32.36 / $54.95	Professional	TC	$18.20	$32.36	$54.95
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $75.86 / $169.82	Professional		$69.18	$75.86	$169.82
United Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $25.70 / $61.66	Professional	26	$21.38	$25.70	$61.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $43.65 / $52.48 / $102.33	Professional	TC	$43.65	$52.48	$102.33