Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $151.36 / $512.86 / $724.44	Facility		$151.36	$512.86	$724.44
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $45.71 / $72.44	Facility	26	$34.67	$45.71	$72.44
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $107.15 / $512.86 / $602.56	Facility	TC	$107.15	$512.86	$602.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $30.20 / $52.48 / $169.82	Professional		$30.20	$52.48	$169.82
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.94 / $13.49 / $42.66	Professional	26	$7.94	$13.49	$42.66
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $20.89 / $32.36 / $85.11	Professional	TC	$20.89	$32.36	$85.11
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 $85.11 / $102.33 / $151.36	Professional		$85.11	$102.33	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.38 / $35.48 / $39.81	Professional	26	$21.38	$35.48	$39.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $79.43 / $114.82	Professional	TC	$66.07	$79.43	$114.82
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $47.86 / $123.03 / $724.44	Facility		$47.86	$123.03	$724.44
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $34.67 / $45.71 / $72.44	Facility	26	$34.67	$45.71	$72.44
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $85.11 / $512.86 / $870.96	Facility	TC	$85.11	$512.86	$870.96
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.66 / $112.20 / $169.82	Professional		$61.66	$112.20	$169.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $14.13 / $32.36 / $60.26	Professional	26	$14.13	$32.36	$60.26
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $83.18 / $117.49	Professional	TC	$41.69	$83.18	$117.49
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $165.96 / $239.88	Professional		$134.90	$165.96	$239.88
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $43.65 / $70.79	Professional	26	$39.81	$43.65	$70.79
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $123.03 / $177.83	Professional	TC	$95.50	$123.03	$177.83
Providence Facility/Professional Facility Modifier Low / Median / High Price $33.88 / $53.70 / $107.15	Facility		$33.88	$53.70	$107.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $37.15 / $79.43 / $109.65	Professional		$37.15	$79.43	$109.65
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $9.12 / $21.38 / $39.81	Professional	26	$9.12	$21.38	$39.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $25.12 / $36.31 / $85.11	Professional	TC	$25.12	$36.31	$85.11
United Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $107.15 / $204.17	Professional		$91.20	$107.15	$204.17
United Facility/Professional Professional Modifier 26 Low / Median / High Price $27.54 / $33.11 / $67.61	Professional	26	$27.54	$33.11	$67.61
United Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $79.43 / $138.04	Professional	TC	$58.88	$79.43	$138.04