Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $42.66 / $67.61	Facility	26	$28.18	$42.66	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $154.88 / $316.23	Professional		$112.20	$154.88	$316.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $51.29 / $120.23	Professional	26	$36.31	$51.29	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $107.15 / $208.93	Professional	TC	$75.86	$107.15	$208.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $100.00 / $165.96	Professional		$85.11	$100.00	$165.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $56.23	Professional	26	$41.69	$51.29	$56.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.90 / $95.50 / $213.80	Professional		$38.90	$95.50	$213.80
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $39.81 / $42.66	Professional	26	$39.81	$39.81	$42.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $331.13	Professional		$131.83	$190.55	$331.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $102.33	Professional	26	$44.67	$60.26	$102.33
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $125.89 / $223.87	Professional	TC	$93.33	$125.89	$223.87
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $275.42 / $275.42 / $275.42	Facility	26	$275.42	$275.42	$275.42
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,096.48 / $1,122.02 / $1,122.02	Professional		$1,096.48	$1,122.02	$1,122.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $446.68 / $446.68	Professional	26	$446.68	$446.68	$446.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $891.25 / $891.25 / $891.25	Professional	TC	$891.25	$891.25	$891.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $28.18 / $35.48 / $56.23	Facility	26	$28.18	$35.48	$56.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $173.78 / $316.23	Professional		$114.82	$173.78	$316.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $36.31 / $56.23 / $102.33	Professional	26	$36.31	$56.23	$102.33
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $117.49 / $213.80	Professional	TC	$77.62	$117.49	$213.80
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.88 / $107.15	Professional		$32.36	$33.88	$107.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $162.18 / $371.54	Professional		$47.86	$162.18	$371.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.47 / $48.98 / $70.79	Facility	26	$10.47	$48.98	$70.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $316.23	Professional		$131.83	$190.55	$316.23
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $60.26 / $95.50	Professional	26	$44.67	$60.26	$95.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $125.89 / $213.80	Professional	TC	$91.20	$125.89	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $158.49 / $281.84	Professional		$114.82	$158.49	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $81.28	Professional	26	$37.15	$50.12	$81.28
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $102.33 / $204.17	Professional	TC	$75.86	$102.33	$204.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $138.04 / $165.96	Professional		$131.83	$138.04	$165.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $43.65 / $52.48	Professional	26	$41.69	$43.65	$52.48
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $95.50 / $112.20	Professional	TC	$89.13	$95.50	$112.20