Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $102.33 / $112.20	Facility	26	$100.00	$102.33	$112.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $758.58	Professional		$208.93	$295.12	$758.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $158.49 / $489.78	Professional	26	$112.20	$158.49	$489.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $229.09	Professional	TC	$97.72	$131.83	$229.09
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $331.13 / $331.13 / $331.13	Professional		$331.13	$331.13	$331.13
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $151.36 / $281.84	Professional	26	$147.91	$151.36	$281.84
BCBS Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $263.03 / $407.38	Professional		$151.36	$263.03	$407.38
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $338.84 / $436.52	Professional		$275.42	$338.84	$436.52
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $144.54 / $154.88 / $154.88	Professional	26	$144.54	$154.88	$154.88
Cigna Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $331.13 / $549.54	Professional		$251.19	$331.13	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $177.83 / $302.00	Professional	26	$131.83	$177.83	$302.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $158.49 / $263.03	Professional	TC	$117.49	$158.49	$263.03
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $954.99 / $954.99 / $954.99	Facility	26	$954.99	$954.99	$954.99
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,778.28 / $2,454.71 / $2,454.71	Professional		$1,778.28	$2,454.71	$2,454.71
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $954.99 / $1,258.93 / $1,258.93	Professional	26	$954.99	$1,258.93	$1,258.93
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $831.76 / $1,174.90 / $1,174.90	Professional	TC	$831.76	$1,174.90	$1,174.90
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $102.33 / $112.20	Facility	26	$100.00	$102.33	$112.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $389.05 / $758.58	Professional		$204.17	$389.05	$758.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $112.20 / $218.78 / $478.63	Professional	26	$112.20	$218.78	$478.63
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $177.83 / $302.00	Professional	TC	$93.33	$177.83	$302.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $109.65 / $239.88	Professional		$32.36	$109.65	$239.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $436.52 / $512.86 / $549.54	Professional		$436.52	$512.86	$549.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $331.13 / $549.54	Professional		$245.47	$331.13	$549.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $128.82 / $173.78 / $288.40	Professional	26	$128.82	$173.78	$288.40
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $154.88 / $245.47	Professional	TC	$112.20	$154.88	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $251.19 / $371.54 / $478.63	Professional		$251.19	$371.54	$478.63
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.83 / $194.98 / $251.19	Professional	26	$131.83	$194.98	$251.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $173.78 / $229.09	Professional	TC	$117.49	$173.78	$229.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $281.84 / $281.84 / $288.40	Professional		$281.84	$281.84	$288.40
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $147.91 / $147.91 / $154.88	Professional	26	$147.91	$147.91	$154.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $131.83 / $138.04	Professional	TC	$131.83	$131.83	$138.04