Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $6.76 / $8.44 / $16.22	Facility	26	$6.76	$8.44	$16.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.44 / $10.47 / $26.13	Professional	26	$8.44	$10.47	$26.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $12.24 / $15.42 / $36.68	Professional	TC	$12.24	$15.42	$36.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $22.44 / $25.56 / $30.20	Professional	26	$22.44	$25.56	$30.20
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $24.10 / $30.32 / $30.32	Professional	26	$24.10	$30.32	$30.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.25 / $32.74 / $53.75	Professional	26	$24.25	$32.74	$53.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $35.75 / $47.55 / $77.45	Professional	TC	$35.75	$47.55	$77.45
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.75 / $110.49 / $120.22	Facility	26	$57.75	$110.49	$120.22
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $145.16 / $149.40 / $196.13	Professional	26	$145.16	$149.40	$196.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $183.70 / $183.70 / $303.83	Professional	TC	$183.70	$183.70	$303.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.69 / $33.04 / $43.91	Professional	26	$27.69	$33.04	$43.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $40.60 / $48.45 / $64.37	Professional	TC	$40.60	$48.45	$64.37
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.25 / $32.29 / $52.37	Professional	26	$24.25	$32.29	$52.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $35.85 / $47.00 / $73.65	Professional	TC	$35.85	$47.00	$73.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.31 / $21.14 / $31.83	Professional	26	$15.31	$21.14	$31.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $22.65 / $31.28 / $46.77	Professional	TC	$22.65	$31.28	$46.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $20.14 / $23.23 / $32.08	Professional	26	$20.14	$23.23	$32.08
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $28.00 / $32.70 / $46.99	Professional	TC	$28.00	$32.70	$46.99