Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.15 / $58.33 / $95.36	Facility	26	$44.15	$58.33	$95.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $338.94 / $433.23 / $637.48	Professional		$338.94	$433.23	$637.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.27 / $60.54 / $92.37	Professional	26	$48.27	$60.54	$92.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $290.67 / $370.12 / $532.98	Professional	TC	$290.67	$370.12	$532.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $404.34 / $404.34 / $429.62	Professional		$404.34	$404.34	$429.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $58.52 / $63.78 / $63.78	Professional	26	$58.52	$63.78	$63.78
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.47 / $304.91 / $567.91	Professional		$50.47	$304.91	$567.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $513.72 / $513.72 / $513.72	Professional		$513.72	$513.72	$513.72
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $52.93 / $79.98 / $79.98	Professional	26	$52.93	$79.98	$79.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $407.48 / $558.50 / $860.62	Professional		$407.48	$558.50	$860.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $56.51 / $80.00 / $146.66	Professional	26	$56.51	$80.00	$146.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $339.15 / $474.30 / $728.61	Professional	TC	$339.15	$474.30	$728.61
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $144.40 / $416.00 / $416.00	Facility	26	$144.40	$416.00	$416.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,713.40 / $3,905.69 / $3,905.69	Professional		$3,713.40	$3,905.69	$3,905.69
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $617.51 / $617.51 / $617.51	Professional	26	$617.51	$617.51	$617.51
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $3,576.06 / $3,683.35 / $3,683.35	Professional	TC	$3,576.06	$3,683.35	$3,683.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $499.32 / $744.94 / $872.18	Professional		$499.32	$744.94	$872.18
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.74 / $83.14 / $101.07	Professional	26	$63.74	$83.14	$101.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $435.58 / $568.15 / $690.69	Professional	TC	$435.58	$568.15	$690.69
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $123.50 / $809.90 / $1,134.65	Professional		$123.50	$809.90	$1,134.65
Providence Facility/Professional Professional Modifier Low / Median / High Price $424.56 / $592.10 / $1,085.83	Professional		$424.56	$592.10	$1,085.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.68 / $79.94 / $146.02	Professional	26	$56.68	$79.94	$146.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $350.80 / $476.46 / $728.61	Professional	TC	$350.80	$476.46	$728.61
United Facility/Professional Professional Modifier Low / Median / High Price $338.09 / $469.59 / $768.42	Professional		$338.09	$469.59	$768.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.51 / $66.69 / $120.39	Professional	26	$48.51	$66.69	$120.39
United Facility/Professional Professional Modifier TC Low / Median / High Price $289.58 / $398.18 / $642.60	Professional	TC	$289.58	$398.18	$642.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $363.31 / $424.81 / $577.94	Professional		$363.31	$424.81	$577.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.38 / $54.61 / $73.86	Professional	26	$46.38	$54.61	$73.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $316.93 / $370.19 / $504.08	Professional	TC	$316.93	$370.19	$504.08