Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $28.18 / $38.02	Facility	26	$25.12	$28.18	$38.02
Aetna Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $100.00 / $165.96	Professional		$72.44	$100.00	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $63.10 / $109.65	Professional	TC	$46.77	$63.10	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $89.13 / $128.82	Professional		$43.65	$89.13	$128.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $64.57	Facility	26	$9.77	$45.71	$64.57
Cigna Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $125.89 / $288.40	Professional		$79.43	$125.89	$288.40
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $87.10 / $204.17	Professional	TC	$50.12	$87.10	$204.17
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,148.15 / $1,148.15	Professional		$1,148.15	$1,148.15	$1,148.15
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $933.25 / $933.25 / $933.25	Professional	TC	$933.25	$933.25	$933.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $25.12 / $28.18 / $32.36	Facility	26	$25.12	$28.18	$32.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.44 / $109.65 / $223.87	Professional		$72.44	$109.65	$223.87
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $69.18 / $134.90	Professional	TC	$46.77	$69.18	$134.90
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $87.10	Professional		$32.36	$33.11	$87.10
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $104.71 / $263.03	Professional		$41.69	$104.71	$263.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $9.77 / $45.71 / $64.57	Facility	26	$9.77	$45.71	$64.57
Providence Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $117.49 / $275.42	Professional		$79.43	$117.49	$275.42
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $48.98 / $81.28 / $181.97	Professional	TC	$48.98	$81.28	$181.97
United Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $123.03 / $218.78	Professional		$87.10	$123.03	$218.78
United Facility/Professional Professional Modifier TC Low / Median / High Price $47.86 / $75.86 / $144.54	Professional	TC	$47.86	$75.86	$144.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $109.65 / $131.83	Professional		$104.71	$109.65	$131.83
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $66.07 / $69.18 / $83.18	Professional	TC	$66.07	$69.18	$83.18