Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.48 / $66.07 / $107.15	Facility	26	$52.48	$66.07	$107.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $436.52 / $660.69	Professional		$363.08	$436.52	$660.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $151.36	Professional	26	$52.48	$64.57	$151.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $380.19 / $562.34	Professional	TC	$302.00	$380.19	$562.34
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $426.58 / $446.68 / $707.95	Professional		$426.58	$446.68	$707.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $67.61 / $104.71	Professional	26	$53.70	$67.61	$104.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $229.09 / $229.09 / $229.09	Professional	TC	$229.09	$229.09	$229.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $323.59 / $602.56	Professional		$50.12	$323.59	$602.56
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $741.31 / $741.31 / $741.31	Professional		$741.31	$741.31	$741.31
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $79.43 / $79.43	Professional	26	$57.54	$79.43	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $398.11 / $562.34 / $912.01	Professional		$398.11	$562.34	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $147.91	Professional	26	$56.23	$79.43	$147.91
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $467.74 / $776.25	Professional	TC	$331.13	$467.74	$776.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $416.87 / $416.87 / $416.87	Facility	26	$416.87	$416.87	$416.87
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,715.35 / $3,715.35 / $3,890.45	Professional		$3,715.35	$3,715.35	$3,890.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $616.60 / $616.60 / $616.60	Professional	26	$616.60	$616.60	$616.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,715.35 / $3,715.35 / $3,715.35	Professional	TC	$3,715.35	$3,715.35	$3,715.35
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $58.88 / $81.28	Facility	26	$43.65	$58.88	$81.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $457.09 / $870.96	Professional		$354.81	$457.09	$870.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $64.57 / $117.49	Professional	26	$50.12	$64.57	$117.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $302.00 / $389.05 / $741.31	Professional	TC	$302.00	$389.05	$741.31
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $371.54	Professional		$32.36	$33.11	$371.54
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $457.09 / $831.76 / $1,071.52	Professional		$457.09	$831.76	$1,071.52
Providence Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $562.34 / $1,023.29	Professional		$407.38	$562.34	$1,023.29
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $141.25	Professional	26	$56.23	$79.43	$141.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $331.13 / $467.74 / $776.25	Professional	TC	$331.13	$467.74	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $467.74 / $776.25	Professional		$346.74	$467.74	$776.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $125.89	Professional	26	$48.98	$66.07	$125.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $398.11 / $660.69	Professional	TC	$295.12	$398.11	$660.69
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $478.63 / $575.44	Professional		$338.84	$478.63	$575.44
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $58.88 / $70.79	Professional	26	$42.66	$58.88	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $416.87 / $501.19	Professional	TC	$295.12	$416.87	$501.19