Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $117.49 / $478.63 / $707.95	Facility		$117.49	$478.63	$707.95
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $28.18 / $58.88	Facility	26	$24.55	$28.18	$58.88
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $67.61 / $295.12 / $549.54	Facility	TC	$67.61	$295.12	$549.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $22.91 / $34.67 / $131.83	Professional		$22.91	$34.67	$131.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.08 / $10.96 / $31.62	Professional	26	$7.08	$10.96	$31.62
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $354.81 / $354.81 / $354.81	Professional	50	$354.81	$354.81	$354.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.98 / $28.84 / $66.07	Professional	TC	$16.98	$28.84	$66.07
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 $63.10 / $75.86 / $114.82	Professional		$63.10	$75.86	$114.82
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $15.49 / $26.92 / $28.18	Professional	26	$15.49	$26.92	$28.18
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $63.10 / $89.13	Professional	TC	$50.12	$63.10	$89.13
Moda Health Facility/Professional Facility Modifier Low / Median / High Price $36.31 / $117.49 / $691.83	Facility		$36.31	$117.49	$691.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $28.18 / $70.79	Facility	26	$24.55	$28.18	$70.79
Moda Health Facility/Professional Facility Modifier TC Low / Median / High Price $66.07 / $323.59 / $549.54	Facility	TC	$66.07	$323.59	$549.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $79.43 / $128.82	Professional		$28.84	$79.43	$128.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $9.33 / $23.44 / $56.23	Professional	26	$9.33	$23.44	$56.23
Moda Health Facility/Professional Professional Modifier 50 Low / Median / High Price $46.77 / $46.77 / $354.81	Professional	50	$46.77	$46.77	$354.81
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $29.51 / $63.10 / $91.20	Professional	TC	$29.51	$63.10	$91.20
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $128.82 / $186.21	Professional		$104.71	$128.82	$186.21
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 $74.13 / $97.72 / $138.04	Professional	TC	$74.13	$97.72	$138.04
Providence Facility/Professional Facility Modifier Low / Median / High Price $25.70 / $42.66 / $81.28	Facility		$25.70	$42.66	$81.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $28.84 / $61.66 / $85.11	Professional		$28.84	$61.66	$85.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $6.46 / $15.49 / $28.18	Professional	26	$6.46	$15.49	$28.18
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $19.95 / $28.18 / $66.07	Professional	TC	$19.95	$28.18	$66.07
United Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $81.28 / $177.83	Professional		$69.18	$81.28	$177.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $23.44 / $57.54	Professional	26	$19.95	$23.44	$57.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $57.54 / $109.65	Professional	TC	$45.71	$57.54	$109.65