Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.89 / $112.12 / $197.14	Facility	26	$101.89	$112.12	$197.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $309.74 / $367.27 / $825.94	Professional		$309.74	$367.27	$825.94
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.64 / $131.81 / $229.15	Professional	26	$102.64	$131.81	$229.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $199.00 / $230.17 / $451.91	Professional	TC	$199.00	$230.17	$451.91
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $602.80 / $602.80 / $602.80	Professional		$602.80	$602.80	$602.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $135.78 / $332.27 / $542.07	Professional		$135.78	$332.27	$542.07
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $144.72 / $150.56 / $153.19	Professional	26	$144.72	$150.56	$153.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $328.77 / $468.51 / $764.80	Professional		$328.77	$468.51	$764.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.34 / $175.15 / $291.98	Professional	26	$129.34	$175.15	$291.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.87 / $288.31 / $487.16	Professional	TC	$193.87	$288.31	$487.16
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $357.19 / $767.93 / $767.93	Facility	26	$357.19	$767.93	$767.93
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,872.34 / $2,872.34 / $3,891.45	Professional		$2,872.34	$2,872.34	$3,891.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $948.42 / $948.42 / $1,248.45	Professional	26	$948.42	$948.42	$1,248.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,923.92 / $1,923.92 / $2,643.00	Professional	TC	$1,923.92	$1,923.92	$2,643.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $430.58 / $742.93 / $1,048.50	Professional		$430.58	$742.93	$1,048.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $193.86 / $246.05 / $338.07	Professional	26	$193.86	$246.05	$338.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $391.50 / $496.90 / $676.90	Professional	TC	$391.50	$496.90	$676.90
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $179.93 / $399.85 / $739.35	Professional		$179.93	$399.85	$739.35
Providence Facility/Professional Professional Modifier Low / Median / High Price $326.83 / $478.17 / $819.73	Professional		$326.83	$478.17	$819.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $130.22 / $175.15 / $292.06	Professional	26	$130.22	$175.15	$292.06
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $187.60 / $306.08 / $500.11	Professional	TC	$187.60	$306.08	$500.11
United Facility/Professional Professional Modifier Low / Median / High Price $329.23 / $467.54 / $670.38	Professional		$329.23	$467.54	$670.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $133.27 / $194.04 / $246.60	Professional	26	$133.27	$194.04	$246.60
United Facility/Professional Professional Modifier TC Low / Median / High Price $195.43 / $268.11 / $409.30	Professional	TC	$195.43	$268.11	$409.30
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $384.28 / $430.58 / $611.42	Professional		$384.28	$430.58	$611.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $127.27 / $146.03 / $202.49	Professional	26	$127.27	$146.03	$202.49
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $257.02 / $284.55 / $408.94	Professional	TC	$257.02	$284.55	$408.94