Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.13 / $107.15 / $141.25	Facility	26	$74.13	$107.15	$141.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $426.58 / $758.58	Professional		$288.40	$426.58	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $109.65 / $173.78	Professional	26	$67.61	$109.65	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $323.59 / $537.03	Professional	TC	$208.93	$323.59	$537.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $199.53 / $199.53	Professional		$199.53	$199.53	$199.53
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $75.86 / $85.11	Professional	26	$61.66	$75.86	$85.11
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.18 / $251.19 / $338.84	Professional		$69.18	$251.19	$338.84
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $75.86 / $77.62 / $83.18	Professional	26	$75.86	$77.62	$83.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $489.78 / $977.24	Professional		$288.40	$489.78	$977.24
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $102.33 / $194.98	Professional	26	$69.18	$102.33	$194.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $371.54 / $776.25	Professional	TC	$213.80	$371.54	$776.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $741.31 / $741.31 / $741.31	Facility	26	$741.31	$741.31	$741.31
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,467.37 / $3,467.37 / $3,467.37	Professional		$3,467.37	$3,467.37	$3,467.37
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $660.69 / $660.69 / $660.69	Professional	26	$660.69	$660.69	$660.69
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,019.95 / $3,019.95 / $3,090.30	Professional	TC	$3,019.95	$3,019.95	$3,090.30
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $67.61 / $107.15 / $141.25	Facility	26	$67.61	$107.15	$141.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $478.63 / $954.99	Professional		$309.03	$478.63	$954.99
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $123.03 / $208.93	Professional	26	$79.43	$123.03	$208.93
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $338.84 / $602.56	Professional	TC	$218.78	$338.84	$602.56
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $251.19	Professional		$32.36	$33.11	$251.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $309.03 / $1,096.48	Professional		$83.18	$309.03	$1,096.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $93.33 / $131.83	Facility	26	$19.95	$93.33	$131.83
Providence Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $489.78 / $933.25	Professional		$288.40	$489.78	$933.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $102.33 / $165.96	Professional	26	$69.18	$102.33	$165.96
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $213.80 / $346.74 / $758.58	Professional	TC	$213.80	$346.74	$758.58
United Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $467.74 / $831.76	Professional		$302.00	$467.74	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $89.13 / $162.18	Professional	26	$70.79	$89.13	$162.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $371.54 / $645.65	Professional	TC	$229.09	$371.54	$645.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $288.40 / $288.40 / $363.08	Professional		$288.40	$288.40	$363.08
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $81.28 / $97.72	Professional	26	$77.62	$81.28	$97.72
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $208.93 / $208.93 / $263.03	Professional	TC	$208.93	$208.93	$263.03