Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $17.94 / $23.50 / $36.04	Facility	26	$17.94	$23.50	$36.04
Aetna Facility/Professional Professional Modifier Low / Median / High Price $88.50 / $112.49 / $171.90	Professional		$88.50	$112.49	$171.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.20 / $24.74 / $41.50	Professional	26	$19.20	$24.74	$41.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.47 / $87.95 / $131.59	Professional	TC	$66.47	$87.95	$131.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.75 / $97.75 / $97.75	Professional		$97.75	$97.75	$97.75
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.95 / $28.95 / $43.41	Professional	26	$28.95	$28.95	$43.41
BCBS Facility/Professional Professional Modifier Low / Median / High Price $23.22 / $88.58 / $138.49	Professional		$23.22	$88.58	$138.49
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $26.07 / $26.07 / $29.11	Professional	26	$26.07	$26.07	$29.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $120.97 / $233.02	Professional		$85.11	$120.97	$233.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $22.39 / $31.17 / $56.62	Professional	26	$22.39	$31.17	$56.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $62.76 / $92.17 / $179.63	Professional	TC	$62.76	$92.17	$179.63
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.90 / $136.56 / $136.56	Facility	26	$85.90	$136.56	$136.56
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $873.78 / $873.78 / $1,050.68	Professional		$873.78	$873.78	$1,050.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $198.13 / $198.13 / $226.28	Professional	26	$198.13	$198.13	$226.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $695.99 / $695.99 / $824.33	Professional	TC	$695.99	$695.99	$824.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $149.88 / $199.62 / $483.92	Professional		$149.88	$199.62	$483.92
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $34.90 / $44.30 / $107.40	Professional	26	$34.90	$44.30	$107.40
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $122.37 / $155.31 / $376.52	Professional	TC	$122.37	$155.31	$376.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $30.29 / $111.23 / $223.29	Professional		$30.29	$111.23	$223.29
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $32.15 / $32.15 / $32.15	Facility	26	$32.15	$32.15	$32.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $86.45 / $141.25 / $319.95	Professional		$86.45	$141.25	$319.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $23.14 / $30.30 / $55.54	Professional	26	$23.14	$30.30	$55.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $61.77 / $91.85 / $170.18	Professional	TC	$61.77	$91.85	$170.18
United Facility/Professional Professional Modifier Low / Median / High Price $91.84 / $118.97 / $196.71	Professional		$91.84	$118.97	$196.71
United Facility/Professional Professional Modifier 26 Low / Median / High Price $24.26 / $28.81 / $51.54	Professional	26	$24.26	$28.81	$51.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $66.00 / $90.16 / $149.08	Professional	TC	$66.00	$90.16	$149.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $103.25 / $115.27 / $164.27	Professional		$103.25	$115.27	$164.27
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $22.92 / $26.32 / $36.36	Professional	26	$22.92	$26.32	$36.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $80.34 / $88.95 / $127.91	Professional	TC	$80.34	$88.95	$127.91