Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.16 / $22.41 / $34.29	Facility	26	$17.16	$22.41	$34.29
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.06 / $110.66 / $197.35	Professional		$87.06	$110.66	$197.35
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.23 / $23.64 / $41.62	Professional	26	$18.23	$23.64	$41.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $69.90 / $87.12 / $155.33	Professional	TC	$69.90	$87.12	$155.33
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.68 / $101.28 / $126.60	Professional		$83.68	$101.28	$126.60
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $20.32 / $43.44 / $52.07	Professional	26	$20.32	$43.44	$52.07
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $75.31 / $75.31 / $75.31	Professional	TC	$75.31	$75.31	$75.31
BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.54 / $91.15 / $144.94	Professional		$24.54	$91.15	$144.94
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $25.16 / $25.16 / $27.32	Professional	26	$25.16	$25.16	$27.32
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $30.37	Facility	26	$30.37	$30.37	$30.37
Cigna Facility/Professional Professional Modifier Low / Median / High Price $87.73 / $121.50 / $237.13	Professional		$87.73	$121.50	$237.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.74 / $30.35 / $54.83	Professional	26	$21.74	$30.35	$54.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $65.98 / $95.78 / $181.35	Professional	TC	$65.98	$95.78	$181.35
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $131.81 / $131.81	Facility	26	$85.90	$131.81	$131.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $859.12 / $859.12 / $1,089.08	Professional		$859.12	$859.12	$1,089.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $211.35 / $211.35 / $216.60	Professional	26	$211.35	$211.35	$216.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $689.44 / $689.44 / $872.40	Professional	TC	$689.44	$689.44	$872.40
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $156.88 / $207.08 / $344.28	Professional		$156.88	$207.08	$344.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.64 / $42.70 / $103.52	Professional	26	$33.64	$42.70	$103.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $129.52 / $164.39 / $398.52	Professional	TC	$129.52	$164.39	$398.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.19 / $117.77 / $220.71	Professional		$29.19	$117.77	$220.71
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $30.37 / $30.37 / $30.37	Facility	26	$30.37	$30.37	$30.37
Providence Facility/Professional Professional Modifier Low / Median / High Price $89.66 / $142.19 / $316.80	Professional		$89.66	$142.19	$316.80
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $21.83 / $29.20 / $52.59	Professional	26	$21.83	$29.20	$52.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $64.81 / $95.77 / $172.87	Professional	TC	$64.81	$95.77	$172.87
United Facility/Professional Professional Modifier Low / Median / High Price $91.76 / $109.53 / $183.51	Professional		$91.76	$109.53	$183.51
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.64 / $26.74 / $45.54	Professional	26	$22.64	$26.74	$45.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.05 / $89.48 / $145.19	Professional	TC	$69.05	$89.48	$145.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $107.11 / $119.55 / $170.48	Professional		$107.11	$119.55	$170.48
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.09 / $25.40 / $35.10	Professional	26	$22.09	$25.40	$35.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $85.03 / $94.14 / $135.38	Professional	TC	$85.03	$94.14	$135.38