Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $208.93 / $562.34 / $870.96	Facility		$208.93	$562.34	$870.96
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $33.11 / $58.88	Facility	26	$26.30	$33.11	$58.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $61.66 / $331.13 / $512.86	Facility	TC	$61.66	$331.13	$512.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $37.15 / $120.23	Professional		$22.91	$37.15	$120.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.00 / $33.11	Professional	26	$7.08	$10.00	$33.11
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $15.14 / $26.30 / $69.18	Professional	TC	$15.14	$26.30	$69.18
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 $58.88 / $77.62 / $107.15	Professional		$58.88	$77.62	$107.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $25.70 / $29.51	Professional	26	$15.49	$25.70	$29.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $51.29 / $57.54 / $81.28	Professional	TC	$51.29	$57.54	$81.28
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $34.67 / $223.87 / $776.25	Facility		$34.67	$223.87	$776.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $26.30 / $33.11 / $58.88	Facility	26	$26.30	$33.11	$58.88
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $61.66 / $331.13 / $660.69	Facility	TC	$61.66	$331.13	$660.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $74.13 / $117.49	Professional		$25.12	$74.13	$117.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.55 / $23.44 / $56.23	Professional	26	$9.55	$23.44	$56.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $56.23 / $81.28	Professional	TC	$30.90	$56.23	$81.28
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $117.49 / $169.82	Professional		$95.50	$117.49	$169.82
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $30.90 / $53.70	Professional	26	$28.84	$30.90	$53.70
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $87.10 / $123.03	Professional	TC	$63.10	$87.10	$123.03
Providence Facility/Professional Facility Modifier Low / Median / High Price $23.99 / $39.81 / $75.86	Facility		$23.99	$39.81	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $26.30 / $58.88 / $77.62	Professional		$26.30	$58.88	$77.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $15.49 / $29.51	Professional	26	$6.46	$15.49	$29.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $18.20 / $26.30 / $58.88	Professional	TC	$18.20	$26.30	$58.88
United Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $72.44 / $154.88	Professional		$63.10	$72.44	$154.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $24.55 / $58.88	Professional	26	$19.95	$24.55	$58.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $97.72	Professional	TC	$38.90	$48.98	$97.72