Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.23 / $85.80 / $112.73	Facility	26	$70.23	$85.80	$112.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $219.95 / $300.00 / $555.73	Professional		$219.95	$300.00	$555.73
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.23 / $86.96 / $130.51	Professional	26	$70.23	$86.96	$130.51
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.71 / $209.65 / $391.04	Professional	TC	$149.71	$209.65	$391.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $220.50 / $220.50 / $220.50	Professional		$220.50	$220.50	$220.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $132.86 / $138.66 / $193.25	Professional	26	$132.86	$138.66	$193.25
BCBS Facility/Professional Professional Modifier Low / Median / High Price $85.74 / $200.44 / $324.30	Professional		$85.74	$200.44	$324.30
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $79.70 / $79.70 / $85.98	Professional	26	$79.70	$79.70	$85.98
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $396.79 / $790.26	Professional		$255.00	$396.79	$790.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.80 / $95.49 / $175.63	Professional	26	$65.80	$95.49	$175.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $178.50 / $295.37 / $606.36	Professional	TC	$178.50	$295.37	$606.36
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $618.08 / $776.08 / $792.40	Facility	26	$618.08	$776.08	$792.40
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,081.89 / $3,174.35 / $3,174.35	Professional		$3,081.89	$3,174.35	$3,174.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $554.78 / $554.78 / $683.18	Professional	26	$554.78	$554.78	$683.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,625.91 / $2,704.69 / $2,704.69	Professional	TC	$2,625.91	$2,704.69	$2,704.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $351.72 / $450.02 / $1,199.40	Professional		$351.72	$450.02	$1,199.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $106.39 / $135.04 / $327.36	Professional	26	$106.39	$135.04	$327.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $283.43 / $359.73 / $872.08	Professional	TC	$283.43	$359.73	$872.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $98.53 / $275.52 / $551.19	Professional		$98.53	$275.52	$551.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.97 / $96.97 / $96.97	Facility	26	$96.97	$96.97	$96.97
Providence Facility/Professional Professional Modifier Low / Median / High Price $255.00 / $426.09 / $850.42	Professional		$255.00	$426.09	$850.42
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $71.34 / $90.62 / $168.41	Professional	26	$71.34	$90.62	$168.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $178.50 / $287.00 / $608.48	Professional	TC	$178.50	$287.00	$608.48
United Facility/Professional Professional Modifier Low / Median / High Price $262.14 / $392.26 / $646.04	Professional		$262.14	$392.26	$646.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.65 / $91.67 / $160.41	Professional	26	$73.65	$91.67	$160.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $193.66 / $284.70 / $494.71	Professional	TC	$193.66	$284.70	$494.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $221.68 / $248.63 / $352.74	Professional		$221.68	$248.63	$352.74
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.84 / $80.52 / $111.00	Professional	26	$69.84	$80.52	$111.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.84 / $177.49 / $1,100.00	Professional	TC	$151.84	$177.49	$1,100.00