Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $61.66 / $61.66	Facility	26	$50.12	$61.66	$61.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $251.19 / $436.52	Professional		$173.78	$251.19	$436.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $63.10 / $109.65	Professional	26	$51.29	$63.10	$109.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $173.78 / $354.81	Professional	TC	$123.03	$173.78	$354.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $158.49 / $234.42	Professional		$131.83	$158.49	$234.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $56.23 / $109.65	Professional	26	$45.71	$56.23	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $162.18 / $208.93	Professional		$50.12	$162.18	$208.93
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $57.54 / $60.26	Professional	26	$56.23	$57.54	$60.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $302.00 / $645.65	Professional		$186.21	$302.00	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $141.25	Professional	26	$50.12	$75.86	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $229.09 / $489.78	Professional	TC	$131.83	$229.09	$489.78
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.54 / $549.54 / $549.54	Facility	26	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,344.23 / $2,344.23 / $2,344.23	Professional		$2,344.23	$2,344.23	$2,344.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Professional	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional	TC	$2,398.83	$2,398.83	$2,398.83
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $61.66 / $97.72	Facility	26	$48.98	$61.66	$97.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $295.12 / $575.44	Professional		$186.21	$295.12	$575.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $141.25	Professional	26	$52.48	$72.44	$141.25
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $194.98 / $389.05	Professional	TC	$128.82	$194.98	$389.05
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $162.18	Professional		$32.36	$33.11	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $186.21 / $446.68	Professional		$60.26	$186.21	$446.68
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $97.72	Facility	26	$14.45	$67.61	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $309.03 / $602.56	Professional		$186.21	$309.03	$602.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $120.23	Professional	26	$50.12	$70.79	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $218.78 / $478.63	Professional	TC	$128.82	$218.78	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $288.40 / $524.81	Professional		$204.17	$288.40	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $112.20	Professional	26	$51.29	$64.57	$112.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $218.78 / $407.38	Professional	TC	$144.54	$218.78	$407.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $194.98 / $234.42	Professional		$186.21	$194.98	$234.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $58.88 / $70.79	Professional	26	$57.54	$58.88	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $162.18	Professional	TC	$162.18	$162.18	$162.18