Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $75.86 / $81.28 / $123.03	Facility	26	$75.86	$81.28	$123.03
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 $79.43 / $91.20 / $275.42	Professional	26	$79.43	$91.20	$275.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $338.84 / $478.63	Professional	TC	$281.84	$338.84	$478.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $436.52 / $467.74	Professional		$389.05	$436.52	$467.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $95.50 / $131.83	Professional	26	$77.62	$95.50	$131.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $316.23 / $616.60	Professional		$74.13	$316.23	$616.60
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $512.86 / $758.58	Professional		$177.83	$512.86	$758.58
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $257.04 / $257.04	Professional	26	$87.10	$257.04	$257.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $512.86 / $851.14	Professional		$316.23	$512.86	$851.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $112.20 / $186.21	Professional	26	$83.18	$112.20	$186.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $251.19 / $407.38 / $691.83	Professional	TC	$251.19	$407.38	$691.83
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Facility	26	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,754.23 / $3,715.35 / $3,715.35	Professional		$2,754.23	$3,715.35	$3,715.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $676.08 / $676.08 / $776.25	Professional	26	$676.08	$676.08	$776.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,187.76 / $3,019.95 / $3,019.95	Professional	TC	$2,187.76	$3,019.95	$3,019.95
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $64.57 / $81.28 / $123.03	Facility	26	$64.57	$81.28	$123.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $446.68 / $891.25	Professional		$363.08	$446.68	$891.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $77.62 / $91.20 / $190.55	Professional	26	$77.62	$91.20	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $281.84 / $354.81 / $691.83	Professional	TC	$281.84	$354.81	$691.83
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $67.61 / $354.81	Professional		$32.36	$67.61	$354.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $524.81 / $1,513.56	Professional		$154.88	$524.81	$1,513.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $537.03 / $933.25	Professional		$323.59	$537.03	$933.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.18 / $114.82 / $173.78	Professional	26	$83.18	$114.82	$173.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $257.04 / $407.38 / $691.83	Professional	TC	$257.04	$407.38	$691.83
United Facility/Professional Professional Modifier Low / Median / High Price $316.23 / $426.58 / $660.69	Professional		$316.23	$426.58	$660.69
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $93.33 / $151.36	Professional	26	$72.44	$93.33	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $239.88 / $338.84 / $512.86	Professional	TC	$239.88	$338.84	$512.86
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 $64.57 / $89.13 / $107.15	Professional	26	$64.57	$89.13	$107.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $389.05 / $467.74	Professional	TC	$275.42	$389.05	$467.74