Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.88 / $55.38 / $99.10	Facility	26	$45.88	$55.38	$99.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $326.19 / $418.33 / $614.75	Professional		$326.19	$418.33	$614.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.32 / $63.05 / $86.49	Professional	26	$50.32	$63.05	$86.49
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $161.25 / $206.91 / $291.50	Professional	52	$161.25	$206.91	$291.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $273.70 / $351.36 / $522.76	Professional	TC	$273.70	$351.36	$522.76
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.30 / $281.95 / $525.17	Professional		$53.30	$281.95	$525.17
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $54.56 / $58.75 / $58.75	Professional	26	$54.56	$58.75	$58.75
Cigna Facility/Professional Professional Modifier Low / Median / High Price $400.96 / $555.90 / $901.26	Professional		$400.96	$555.90	$901.26
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.06 / $81.56 / $137.41	Professional	26	$58.06	$81.56	$137.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $343.06 / $465.68 / $766.66	Professional	TC	$343.06	$465.68	$766.66
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.82 / $495.00 / $495.00	Facility	26	$141.82	$495.00	$495.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,899.13 / $2,986.11 / $3,500.93	Professional		$2,899.13	$2,986.11	$3,500.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $873.43 / $873.43 / $873.43	Professional	26	$873.43	$873.43	$873.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,483.58 / $2,558.09 / $3,038.18	Professional	TC	$2,483.58	$2,558.09	$3,038.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $471.24 / $703.05 / $910.78	Professional		$471.24	$703.05	$910.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.64 / $85.62 / $104.09	Professional	26	$65.64	$85.62	$104.09
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $405.60 / $529.04 / $643.15	Professional	TC	$405.60	$529.04	$643.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.16 / $489.01 / $919.91	Professional		$74.16	$489.01	$919.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $419.48 / $597.65 / $1,007.22	Professional		$419.48	$597.65	$1,007.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.40 / $81.91 / $137.41	Professional	26	$59.40	$81.91	$137.41
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $348.40 / $465.68 / $772.89	Professional	TC	$348.40	$465.68	$772.89
United Facility/Professional Professional Modifier Low / Median / High Price $331.74 / $482.26 / $790.91	Professional		$331.74	$482.26	$790.91
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.53 / $69.48 / $114.33	Professional	26	$50.53	$69.48	$114.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $298.77 / $413.02 / $665.27	Professional	TC	$298.77	$413.02	$665.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $342.87 / $400.98 / $545.47	Professional		$342.87	$400.98	$545.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.76 / $56.26 / $76.06	Professional	26	$47.76	$56.26	$76.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $295.11 / $344.72 / $469.40	Professional	TC	$295.11	$344.72	$469.40