Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $29.46 / $38.20 / $58.05	Facility	26	$29.46	$38.20	$58.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $141.76 / $182.09 / $661.22	Professional		$141.76	$182.09	$661.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.46 / $38.61 / $131.44	Professional	26	$29.46	$38.61	$131.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.30 / $143.88 / $303.39	Professional	TC	$112.30	$143.88	$303.39
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $152.74 / $162.29 / $248.21	Professional		$152.74	$162.29	$248.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.64 / $47.64 / $52.46	Professional	26	$47.64	$47.64	$52.46
BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.58 / $162.65 / $226.64	Professional		$37.58	$162.65	$226.64
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $42.55 / $48.09 / $48.09	Professional	26	$42.55	$48.09	$48.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.16 / $262.89 / $446.26	Professional		$165.16	$262.89	$446.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.97 / $56.08 / $92.45	Professional	26	$37.97	$56.08	$92.45
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $132.61 / $207.26 / $355.24	Professional	TC	$132.61	$207.26	$355.24
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $107.73 / $221.68 / $221.68	Facility	26	$107.73	$221.68	$221.68
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,481.01 / $1,525.44 / $1,736.48	Professional		$1,481.01	$1,525.44	$1,736.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $501.94 / $501.94 / $501.94	Professional	26	$501.94	$501.94	$501.94
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,231.75 / $1,268.71 / $1,373.85	Professional	TC	$1,231.75	$1,268.71	$1,373.85
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $190.93 / $345.58 / $525.00	Professional		$190.93	$345.58	$525.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.36 / $77.95 / $174.68	Professional	26	$62.36	$77.95	$174.68
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $223.57 / $279.45 / $626.24	Professional	TC	$223.57	$279.45	$626.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $52.37 / $185.06 / $375.24	Professional		$52.37	$185.06	$375.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $174.39 / $268.35 / $447.98	Professional		$174.39	$268.35	$447.98
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.88 / $60.33 / $95.28	Professional	26	$38.88	$60.33	$95.28
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $141.18 / $221.90 / $359.46	Professional	TC	$141.18	$221.90	$359.46
United Facility/Professional Professional Modifier Low / Median / High Price $187.95 / $234.94 / $362.34	Professional		$187.95	$234.94	$362.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.54 / $47.65 / $74.16	Professional	26	$39.54	$47.65	$74.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $157.68 / $189.07 / $289.20	Professional	TC	$157.68	$189.07	$289.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $170.88 / $190.93 / $271.92	Professional		$170.88	$190.93	$271.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $37.27 / $43.00 / $59.31	Professional	26	$37.27	$43.00	$59.31
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $133.62 / $147.93 / $212.60	Professional	TC	$133.62	$147.93	$212.60