Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.95 / $19.37 / $30.76	Facility	26	$14.95	$19.37	$30.76
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.94 / $212.56 / $689.36	Professional		$147.94	$212.56	$689.36
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.95 / $20.91 / $50.39	Professional	26	$14.95	$20.91	$50.39
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $132.99 / $174.84 / $330.38	Professional	TC	$132.99	$174.84	$330.38
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $167.14 / $167.14 / $273.76	Professional		$167.14	$167.14	$273.76
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $17.57 / $42.85 / $42.85	Professional	26	$17.57	$42.85	$42.85
BCBS Facility/Professional Professional Modifier Low / Median / High Price $19.21 / $173.68 / $236.96	Professional		$19.21	$173.68	$236.96
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $108.00 / $108.00 / $108.00	Professional		$108.00	$108.00	$108.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $21.75 / $22.45 / $24.35	Professional	26	$21.75	$22.45	$24.35
Cigna Facility/Professional Professional Modifier Low / Median / High Price $171.05 / $266.82 / $447.66	Professional		$171.05	$266.82	$447.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $18.95 / $28.73 / $45.78	Professional	26	$18.95	$28.73	$45.78
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $156.41 / $241.93 / $408.50	Professional	TC	$156.41	$241.93	$408.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $55.06 / $113.34 / $113.34	Facility	26	$55.06	$113.34	$113.34
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,459.76 / $1,459.76 / $1,808.10	Professional		$1,459.76	$1,459.76	$1,808.10
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $147.05 / $147.05 / $185.33	Professional	26	$147.05	$147.05	$185.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,312.71 / $1,312.71 / $1,622.78	Professional	TC	$1,312.71	$1,312.71	$1,622.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.70 / $342.11 / $513.96	Professional		$56.70	$342.11	$513.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $31.87 / $39.84 / $89.28	Professional	26	$31.87	$39.84	$89.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $264.20 / $330.26 / $740.08	Professional	TC	$264.20	$330.26	$740.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $24.89 / $212.70 / $260.81	Professional		$24.89	$212.70	$260.81
Providence Facility/Professional Professional Modifier Low / Median / High Price $178.90 / $271.61 / $453.73	Professional		$178.90	$271.61	$453.73
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $19.59 / $29.42 / $45.78	Professional	26	$19.59	$29.42	$45.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $166.53 / $250.70 / $409.11	Professional	TC	$166.53	$250.70	$409.11
United Facility/Professional Professional Modifier Low / Median / High Price $191.16 / $242.69 / $378.09	Professional		$191.16	$242.69	$378.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $19.92 / $23.83 / $37.59	Professional	26	$19.92	$23.83	$37.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $178.14 / $218.86 / $340.50	Professional	TC	$178.14	$218.86	$340.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $176.96 / $196.81 / $281.61	Professional		$176.96	$196.81	$281.61
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $19.05 / $21.97 / $30.32	Professional	26	$19.05	$21.97	$30.32
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $157.91 / $174.83 / $251.30	Professional	TC	$157.91	$174.83	$251.30