Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.61 / $74.18 / $100.48	Facility	26	$56.61	$74.18	$100.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $422.42 / $638.00	Professional		$250.00	$422.42	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.57 / $101.24 / $189.00	Professional	26	$58.57	$101.24	$189.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.06 / $311.24 / $470.23	Professional	TC	$190.06	$311.24	$470.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $244.55 / $349.59 / $528.29	Professional		$244.55	$349.59	$528.29
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.43 / $112.65 / $157.30	Professional	26	$52.43	$112.65	$157.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.84 / $214.62 / $327.75	Professional		$56.84	$214.62	$327.75
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $282.64 / $318.00 / $470.69	Professional		$282.64	$318.00	$470.69
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $64.88 / $64.88 / $69.83	Professional	26	$64.88	$64.88	$69.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $283.06 / $472.03 / $884.00	Professional		$283.06	$472.03	$884.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.98 / $82.94 / $149.57	Professional	26	$53.98	$82.94	$149.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $224.63 / $380.21 / $746.10	Professional	TC	$224.63	$380.21	$746.10
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $502.88 / $632.64 / $647.12	Facility	26	$502.88	$632.64	$647.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,916.35 / $3,077.22 / $3,113.67	Professional		$2,916.35	$3,077.22	$3,113.67
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $680.25 / $680.25 / $680.25	Professional	26	$680.25	$680.25	$680.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,539.44 / $2,677.57 / $2,677.57	Professional	TC	$2,539.44	$2,677.57	$2,677.57
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $412.01 / $543.86 / $1,318.44	Professional		$412.01	$543.86	$1,318.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.62 / $109.94 / $156.86	Professional	26	$86.62	$109.94	$156.86
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $341.87 / $433.92 / $1,051.92	Professional	TC	$341.87	$433.92	$1,051.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.81 / $317.41 / $465.02	Professional		$77.81	$317.41	$465.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $297.64 / $514.40 / $968.58	Professional		$297.64	$514.40	$968.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.03 / $82.17 / $149.57	Professional	26	$58.03	$82.17	$149.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $232.73 / $369.60 / $735.09	Professional	TC	$232.73	$369.60	$735.09
United Facility/Professional Professional Modifier Low / Median / High Price $322.20 / $458.95 / $801.08	Professional		$322.20	$458.95	$801.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.27 / $75.02 / $142.24	Professional	26	$59.27	$75.02	$142.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $277.22 / $373.18 / $694.88	Professional	TC	$277.22	$373.18	$694.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $263.37 / $294.18 / $419.19	Professional		$263.37	$294.18	$419.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.87 / $65.54 / $90.44	Professional	26	$56.87	$65.54	$90.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $206.50 / $241.37 / $1,400.00	Professional	TC	$206.50	$241.37	$1,400.00