Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $61.66 / $63.10	Facility	26	$50.12	$61.66	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $263.03 / $501.19	Professional		$194.98	$263.03	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $61.66 / $100.00	Professional	26	$50.12	$61.66	$100.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $181.97 / $436.52	Professional	TC	$141.25	$181.97	$436.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $169.82 / $389.05	Professional		$141.25	$169.82	$389.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $79.43 / $79.43 / $79.43	Professional	26	$79.43	$79.43	$79.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $181.97 / $263.03	Professional		$60.26	$181.97	$263.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $56.23 / $58.88	Professional	26	$56.23	$56.23	$58.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $302.00 / $645.65	Professional		$190.55	$302.00	$645.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $114.82	Professional	26	$51.29	$67.61	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $218.78 / $562.34	Professional	TC	$138.04	$218.78	$562.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $562.34 / $562.34 / $562.34	Facility	26	$562.34	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,388.44 / $3,388.44 / $3,388.44	Professional		$3,388.44	$3,388.44	$3,388.44
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $501.19 / $501.19	Professional	26	$436.52	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,090.30 / $3,090.30 / $3,090.30	Professional	TC	$3,090.30	$3,090.30	$3,090.30
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $57.54 / $61.66	Facility	26	$50.12	$57.54	$61.66
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $331.13 / $588.84	Professional		$204.17	$331.13	$588.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $208.93	Professional	26	$52.48	$81.28	$208.93
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $229.09 / $489.78	Professional	TC	$144.54	$229.09	$489.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $181.97	Professional		$32.36	$33.11	$181.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $398.11 / $446.68	Professional		$338.84	$398.11	$446.68
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $302.00 / $660.69	Professional		$186.21	$302.00	$660.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $67.61 / $114.82	Professional	26	$51.29	$67.61	$114.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $213.80 / $562.34	Professional	TC	$128.82	$213.80	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $338.84 / $575.44	Professional		$204.17	$338.84	$575.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $63.10 / $114.82	Professional	26	$48.98	$63.10	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $257.04 / $478.63	Professional	TC	$144.54	$257.04	$478.63
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $223.87	Professional		$213.80	$213.80	$223.87
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $58.88 / $61.66	Professional	26	$58.88	$58.88	$61.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $151.36 / $158.49	Professional	TC	$151.36	$151.36	$158.49