Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.95 / $93.29 / $127.04	Facility	26	$81.95	$93.29	$127.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $295.64 / $327.54 / $476.01	Professional		$295.64	$327.54	$476.01
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $81.41 / $88.53 / $127.04	Professional	26	$81.41	$88.53	$127.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $214.82 / $233.04 / $322.16	Professional	TC	$214.82	$233.04	$322.16
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $270.47 / $270.47 / $270.47	Professional		$270.47	$270.47	$270.47
BCBS Facility/Professional Professional Modifier Low / Median / High Price $77.04 / $234.90 / $453.72	Professional		$77.04	$234.90	$453.72
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $82.90 / $97.66 / $97.66	Professional	26	$82.90	$97.66	$97.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $300.32 / $381.50 / $611.54	Professional		$300.32	$381.50	$611.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.82 / $114.03 / $176.19	Professional	26	$87.82	$114.03	$176.19
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $211.77 / $268.92 / $438.57	Professional	TC	$211.77	$268.92	$438.57
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $195.59 / $378.47 / $406.32	Facility	26	$195.59	$378.47	$406.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,999.20 / $2,227.92 / $2,332.94	Professional		$1,999.20	$2,227.92	$2,332.94
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $684.00 / $684.00 / $684.30	Professional	26	$684.00	$684.00	$684.30
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,517.19 / $1,600.96 / $1,648.65	Professional	TC	$1,517.19	$1,600.96	$1,648.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $257.30 / $403.68 / $484.42	Professional		$257.30	$403.68	$484.42
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.13 / $123.73 / $145.57	Professional	26	$105.13	$123.73	$145.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $244.74 / $288.04 / $338.87	Professional	TC	$244.74	$288.04	$338.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $293.10 / $293.10 / $293.10	Professional		$293.10	$293.10	$293.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $300.32 / $391.13 / $649.53	Professional		$300.32	$391.13	$649.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $88.85 / $114.90 / $176.19	Professional	26	$88.85	$114.90	$176.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $211.77 / $276.98 / $445.36	Professional	TC	$211.77	$276.98	$445.36
United Facility/Professional Professional Modifier Low / Median / High Price $222.77 / $322.37 / $539.98	Professional		$222.77	$322.37	$539.98
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.16 / $96.47 / $149.09	Professional	26	$70.16	$96.47	$149.09
United Facility/Professional Professional Modifier TC Low / Median / High Price $156.99 / $230.25 / $365.04	Professional	TC	$156.99	$230.25	$365.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $229.69 / $257.30 / $365.13	Professional		$229.69	$257.30	$365.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.02 / $79.40 / $109.32	Professional	26	$69.02	$79.40	$109.32
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $160.66 / $177.90 / $255.81	Professional	TC	$160.66	$177.90	$255.81