Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $67.61 / $87.10	Facility	26	$58.88	$67.61	$87.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $138.04 / $302.00	Professional		$107.15	$138.04	$302.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $38.90 / $48.98 / $107.15	Professional	TC	$38.90	$48.98	$107.15
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $144.54	Professional		$144.54	$144.54	$144.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $151.36 / $204.17	Professional		$97.72	$151.36	$204.17
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $181.97 / $263.03	Professional		$141.25	$181.97	$263.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $295.12	Professional		$123.03	$169.82	$295.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $42.66 / $64.57 / $128.82	Professional	TC	$42.66	$64.57	$128.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $588.84 / $588.84 / $588.84	Facility	26	$588.84	$588.84	$588.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,148.15 / $1,202.26 / $1,202.26	Professional		$1,148.15	$1,202.26	$1,202.26
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $602.56 / $602.56 / $602.56	Professional	TC	$602.56	$602.56	$602.56
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $58.88 / $67.61 / $77.62	Facility	26	$58.88	$67.61	$77.62
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $186.21 / $363.08	Professional		$107.15	$186.21	$363.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $38.02 / $74.13 / $154.88	Professional	TC	$38.02	$74.13	$154.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $257.04 / $275.42	Professional		$213.80	$257.04	$275.42
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $162.18 / $295.12	Professional		$123.03	$162.18	$295.12
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $41.69 / $61.66 / $117.49	Professional	TC	$41.69	$61.66	$117.49
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $151.36 / $245.47	Professional		$128.82	$151.36	$245.47
United Facility/Professional Professional Modifier TC Low / Median / High Price $44.67 / $60.26 / $104.71	Professional	TC	$44.67	$60.26	$104.71
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $138.04 / $144.54	Professional		$138.04	$138.04	$144.54
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $50.12 / $50.12 / $52.48	Professional	TC	$50.12	$50.12	$52.48