Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $19.95 / $20.89 / $24.55	Facility	26	$19.95	$20.89	$24.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $70.79 / $138.04	Professional		$45.71	$70.79	$138.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $28.18 / $60.26	Professional	26	$19.95	$28.18	$60.26
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $66.07 / $213.80 / $257.04	Professional	50	$66.07	$213.80	$257.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $23.99 / $37.15 / $67.61	Professional	TC	$23.99	$37.15	$67.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $61.66 / $89.13	Professional		$46.77	$61.66	$89.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $19.95 / $28.18 / $47.86	Professional	26	$19.95	$28.18	$47.86
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $134.90 / $134.90 / $134.90	Professional	50	$134.90	$134.90	$134.90
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $26.30 / $31.62 / $34.67	Professional	TC	$26.30	$31.62	$34.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $24.55 / $50.12 / $63.10	Professional		$24.55	$50.12	$63.10
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $28.18 / $28.84 / $30.20	Professional	26	$28.18	$28.84	$30.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $81.28 / $151.36	Professional		$56.23	$81.28	$151.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $33.11 / $63.10	Professional	26	$24.55	$33.11	$63.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $47.86 / $93.33	Professional	TC	$30.90	$47.86	$93.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $190.55 / $190.55 / $190.55	Facility	26	$190.55	$190.55	$190.55
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $501.19 / $562.34 / $562.34	Professional		$501.19	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $323.59 / $323.59	Professional	26	$323.59	$323.59	$323.59
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $323.59 / $323.59	Professional	TC	$323.59	$323.59	$323.59
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $19.05 / $20.89 / $24.55	Facility	26	$19.05	$20.89	$24.55
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $79.43 / $151.36	Professional		$50.12	$79.43	$151.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $21.88 / $33.88 / $66.07	Professional	26	$21.88	$33.88	$66.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $26.92 / $45.71 / $77.62	Professional	TC	$26.92	$45.71	$77.62
Molina Facility/Professional Professional Modifier Low / Median / High Price $25.12 / $32.36 / $57.54	Professional		$25.12	$32.36	$57.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $177.83 / $204.17	Professional		$95.50	$177.83	$204.17
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $7.24 / $33.88 / $48.98	Facility	26	$7.24	$33.88	$48.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $77.62 / $154.88	Professional		$56.23	$77.62	$154.88
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $24.55 / $30.90 / $57.54	Professional	26	$24.55	$30.90	$57.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $30.90 / $43.65 / $91.20	Professional	TC	$30.90	$43.65	$91.20
United Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $81.28 / $123.03	Professional		$57.54	$81.28	$123.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $25.70 / $31.62 / $48.98	Professional	26	$25.70	$31.62	$48.98
United Facility/Professional Professional Modifier TC Low / Median / High Price $32.36 / $45.71 / $69.18	Professional	TC	$32.36	$45.71	$69.18
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $66.07 / $69.18 / $83.18	Professional		$66.07	$69.18	$83.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $30.20 / $36.31	Professional	26	$29.51	$30.20	$36.31
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.15 / $38.90 / $46.77	Professional	TC	$37.15	$38.90	$46.77