Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $109.65 / $144.54	Facility	26	$75.86	$109.65	$144.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $426.58 / $794.33	Professional		$257.04	$426.58	$794.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $123.03 / $269.15	Professional	26	$69.18	$123.03	$269.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $288.40 / $501.19	Professional	TC	$186.21	$288.40	$501.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $79.43 / $134.90	Professional	26	$64.57	$79.43	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	TC	$134.90	$134.90	$134.90
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $223.87 / $288.40	Professional		$70.79	$223.87	$288.40
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $81.28 / $85.11	Professional	26	$79.43	$81.28	$85.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $446.68 / $912.01	Professional		$245.47	$446.68	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $107.15 / $204.17	Professional	26	$70.79	$107.15	$204.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $177.83 / $331.13 / $724.44	Professional	TC	$177.83	$331.13	$724.44
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $776.25 / $776.25 / $776.25	Facility	26	$776.25	$776.25	$776.25
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,548.13 / $3,548.13 / $3,548.13	Professional		$3,548.13	$3,548.13	$3,548.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $691.83 / $691.83	Professional	26	$660.69	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Professional	TC	$3,090.30	$3,090.30	$3,090.30
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $69.18 / $109.65 / $144.54	Facility	26	$69.18	$109.65	$144.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $478.63 / $933.25	Professional		$275.42	$478.63	$933.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $128.82 / $269.15	Professional	26	$83.18	$128.82	$269.15
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $309.03 / $645.65	Professional	TC	$186.21	$309.03	$645.65
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $223.87	Professional		$32.36	$33.11	$223.87
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $251.19 / $660.69	Professional		$85.11	$251.19	$660.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $20.89 / $97.72 / $138.04	Facility	26	$20.89	$97.72	$138.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $457.09 / $870.96	Professional		$257.04	$457.09	$870.96
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $104.71 / $169.82	Professional	26	$70.79	$104.71	$169.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $323.59 / $707.95	Professional	TC	$173.78	$323.59	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $407.38 / $758.58	Professional		$269.15	$407.38	$758.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $91.20 / $169.82	Professional	26	$72.44	$91.20	$169.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $190.55 / $288.40 / $575.44	Professional	TC	$190.55	$288.40	$575.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $269.15 / $323.59	Professional		$257.04	$269.15	$323.59
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $83.18 / $100.00	Professional	26	$83.18	$83.18	$100.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $223.87 / $223.87 / $223.87	Professional	TC	$223.87	$223.87	$223.87