Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.27 / $82.03 / $92.23	Facility	26	$52.27	$82.03	$92.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $223.61 / $360.11 / $638.00	Professional		$223.61	$360.11	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $59.52 / $92.94 / $166.95	Professional	26	$59.52	$92.94	$166.95
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $160.82 / $252.46 / $415.86	Professional	TC	$160.82	$252.46	$415.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $148.66 / $179.53 / $379.65	Professional		$148.66	$179.53	$379.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $60.15 / $99.25 / $117.30	Professional	26	$60.15	$99.25	$117.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.92 / $172.60 / $275.45	Professional		$53.92	$172.60	$275.45
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $59.54 / $59.54 / $64.12	Professional	26	$59.54	$59.54	$64.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.76 / $370.29 / $768.84	Professional		$190.76	$370.29	$768.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.47 / $72.31 / $132.66	Professional	26	$48.47	$72.31	$132.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $137.56 / $290.26 / $634.53	Professional	TC	$137.56	$290.26	$634.53
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $461.28 / $580.79 / $596.96	Facility	26	$461.28	$580.79	$596.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,821.00 / $2,873.43 / $2,896.26	Professional		$2,821.00	$2,873.43	$2,896.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $625.77 / $625.77 / $625.77	Professional	26	$625.77	$625.77	$625.77
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,451.15 / $2,524.69 / $2,524.69	Professional	TC	$2,451.15	$2,524.69	$2,524.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $224.42 / $366.66 / $888.88	Professional		$224.42	$366.66	$888.88
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.47 / $100.86 / $244.52	Professional	26	$79.47	$100.86	$244.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $209.42 / $265.80 / $644.36	Professional	TC	$209.42	$265.80	$644.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $67.84 / $194.20 / $349.89	Professional		$67.84	$194.20	$349.89
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $72.95 / $72.95 / $72.95	Facility	26	$72.95	$72.95	$72.95
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.81 / $404.45 / $746.94	Professional		$199.81	$404.45	$746.94
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.83 / $68.84 / $129.11	Professional	26	$52.83	$68.84	$129.11
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $137.56 / $280.58 / $634.00	Professional	TC	$137.56	$280.58	$634.00
United Facility/Professional Professional Modifier Low / Median / High Price $225.17 / $361.62 / $670.39	Professional		$225.17	$361.62	$670.39
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.76 / $68.56 / $130.28	Professional	26	$54.76	$68.56	$130.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $166.88 / $288.61 / $519.04	Professional	TC	$166.88	$288.61	$519.04
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $189.66 / $212.37 / $301.87	Professional		$189.66	$212.37	$301.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.17 / $60.15 / $83.01	Professional	26	$52.17	$60.15	$83.01
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $137.49 / $160.69 / $1,400.00	Professional	TC	$137.49	$160.69	$1,400.00