Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $112.20 / $125.89	Facility	26	$102.33	$112.20	$125.89
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $380.19 / $588.84	Professional		$323.59	$380.19	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $97.72 / $114.82 / $181.97	Professional	26	$97.72	$114.82	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $269.15 / $371.54	Professional	TC	$218.78	$269.15	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $467.74 / $467.74 / $467.74	Professional		$467.74	$467.74	$467.74
BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $302.00 / $501.19	Professional		$97.72	$302.00	$501.19
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $104.71 / $104.71 / $104.71	Professional	26	$104.71	$104.71	$104.71
Cigna Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $436.52 / $691.83	Professional		$338.84	$436.52	$691.83
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $107.15 / $144.54 / $223.87	Professional	26	$107.15	$144.54	$223.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $302.00 / $489.78	Professional	TC	$223.87	$302.00	$489.78
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,454.71 / $2,884.03 / $2,884.03	Professional		$2,454.71	$2,884.03	$2,884.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $758.58 / $851.14 / $851.14	Professional	26	$758.58	$851.14	$851.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,698.24 / $1,995.26 / $1,995.26	Professional	TC	$1,698.24	$1,995.26	$1,995.26
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $102.33 / $112.20 / $123.03	Facility	26	$102.33	$112.20	$123.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $457.09 / $616.60	Professional		$354.81	$457.09	$616.60
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $138.04 / $190.55	Professional	26	$102.33	$138.04	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $309.03 / $407.38	Professional	TC	$245.47	$309.03	$407.38
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $199.53	Professional		$32.36	$33.11	$199.53
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $3.02 / $645.65 / $1,000.00	Professional		$3.02	$645.65	$1,000.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $436.52 / $741.31	Professional		$338.84	$436.52	$741.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $109.65 / $144.54 / $218.78	Professional	26	$109.65	$144.54	$218.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $302.00 / $501.19	Professional	TC	$229.09	$302.00	$501.19
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $363.08 / $588.84	Professional		$269.15	$363.08	$588.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $89.13 / $123.03 / $190.55	Professional	26	$89.13	$123.03	$190.55
United Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $245.47 / $398.11	Professional	TC	$177.83	$245.47	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $331.13 / $331.13	Professional		$316.23	$331.13	$331.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $102.33 / $109.65 / $109.65	Professional	26	$102.33	$109.65	$109.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $223.87 / $223.87	Professional	TC	$213.80	$223.87	$223.87