Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $346.74 / $676.08	Facility		$151.36	$346.74	$676.08
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $30.20 / $81.28	Facility	26	$26.92	$30.20	$81.28
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $85.11 / $346.74 / $575.44	Facility	TC	$85.11	$346.74	$575.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $23.99 / $43.65 / $138.04	Professional		$23.99	$43.65	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $6.03 / $10.96 / $35.48	Professional	26	$6.03	$10.96	$35.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $29.51 / $85.11	Professional	TC	$16.98	$29.51	$85.11
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 / $91.20 / $120.23	Professional		$67.61	$91.20	$120.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $16.22 / $26.92 / $30.90	Professional	26	$16.22	$26.92	$30.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $64.57 / $91.20	Professional	TC	$61.66	$64.57	$91.20
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $39.81 / $120.23 / $676.08	Facility		$39.81	$120.23	$676.08
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $26.92 / $35.48 / $81.28	Facility	26	$26.92	$35.48	$81.28
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $67.61 / $389.05 / $724.44	Facility	TC	$67.61	$389.05	$724.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $30.90 / $83.18 / $134.90	Professional		$30.90	$83.18	$134.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.77 / $25.12 / $60.26	Professional	26	$9.77	$25.12	$60.26
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $46.77 / $50.12	Professional	50	$46.77	$46.77	$50.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $33.88 / $66.07 / $93.33	Professional	TC	$33.88	$66.07	$93.33
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $134.90 / $199.53	Professional		$104.71	$134.90	$199.53
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 / $100.00 / $144.54	Professional	TC	$74.13	$100.00	$144.54
Providence Facility/Professional Facility Modifier Low / Median / High Price $26.30 / $44.67 / $85.11	Facility		$26.30	$44.67	$85.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $29.51 / $61.66 / $91.20	Professional		$29.51	$61.66	$91.20
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 $19.50 / $28.18 / $67.61	Professional	TC	$19.50	$28.18	$67.61
United Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $85.11 / $181.97	Professional		$74.13	$85.11	$181.97
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 $50.12 / $61.66 / $109.65	Professional	TC	$50.12	$61.66	$109.65