Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $75.86 / $93.33	Facility	26	$63.10	$75.86	$93.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $302.00 / $426.58 / $831.76	Professional		$302.00	$426.58	$831.76
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $81.28 / $251.19	Professional	26	$60.26	$81.28	$251.19
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $354.81 / $537.03	Professional	TC	$245.47	$354.81	$537.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $645.65 / $645.65	Professional		$645.65	$645.65	$645.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $56.23 / $120.23	Professional	26	$54.95	$56.23	$120.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.10 / $323.59 / $416.87	Professional		$63.10	$323.59	$416.87
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $354.81 / $354.81	Professional		$354.81	$354.81	$354.81
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $69.18 / $77.62	Professional	26	$69.18	$69.18	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $426.58 / $870.96	Professional		$309.03	$426.58	$870.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $93.33 / $154.88	Professional	26	$61.66	$93.33	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $363.08 / $724.44	Professional	TC	$245.47	$363.08	$724.44
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $457.09 / $457.09 / $457.09	Facility	26	$457.09	$457.09	$457.09
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,691.53 / $3,311.31 / $3,311.31	Professional		$2,691.53	$3,311.31	$3,311.31
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $457.09 / $575.44 / $575.44	Professional	26	$457.09	$575.44	$575.44
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,238.72 / $2,691.53 / $2,691.53	Professional	TC	$2,238.72	$2,691.53	$2,691.53
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $60.26 / $75.86 / $93.33	Facility	26	$60.26	$75.86	$93.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $549.54 / $1,548.82	Professional		$354.81	$549.54	$1,548.82
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $114.82 / $281.84	Professional	26	$63.10	$114.82	$281.84
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $446.68 / $912.01	Professional	TC	$288.40	$446.68	$912.01
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $33.11	Professional		$32.36	$33.11	$33.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $309.03 / $398.11 / $776.25	Professional		$309.03	$398.11	$776.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $85.11 / $147.91	Professional	26	$61.66	$85.11	$147.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $245.47 / $346.74 / $707.95	Professional	TC	$245.47	$346.74	$707.95
United Facility/Professional Professional Modifier Low / Median / High Price $338.84 / $416.87 / $691.83	Professional		$338.84	$416.87	$691.83
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $77.62 / $117.49	Professional	26	$63.10	$77.62	$117.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $338.84 / $575.44	Professional	TC	$263.03	$338.84	$575.44
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $380.19	Professional		$363.08	$363.08	$380.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $69.18 / $72.44	Professional	26	$69.18	$69.18	$72.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $295.12 / $309.03	Professional	TC	$295.12	$295.12	$309.03