Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.75 / $30.87 / $47.70	Facility	26	$23.75	$30.87	$47.70
Aetna Facility/Professional Professional Modifier Low / Median / High Price $205.07 / $272.04 / $683.86	Professional		$205.07	$272.04	$683.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $23.75 / $35.04 / $115.81	Professional	26	$23.75	$35.04	$115.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $181.32 / $232.19 / $447.61	Professional	TC	$181.32	$232.19	$447.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $218.25 / $231.65 / $493.17	Professional		$218.25	$231.65	$493.17
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.76 / $49.26 / $68.28	Professional	26	$29.76	$49.26	$68.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $30.01 / $251.52 / $312.47	Professional		$30.01	$251.52	$312.47
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $172.00 / $341.01 / $520.15	Professional		$172.00	$341.01	$520.15
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $34.65 / $215.48 / $215.48	Professional	26	$34.65	$215.48	$215.48
Cigna Facility/Professional Professional Modifier Low / Median / High Price $223.88 / $315.29 / $558.30	Professional		$223.88	$315.29	$558.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.74 / $45.61 / $74.41	Professional	26	$30.74	$45.61	$74.41
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $193.64 / $292.93 / $488.74	Professional	TC	$193.64	$292.93	$488.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $180.26 / $180.26	Facility	26	$100.00	$180.26	$180.26
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,023.55 / $2,023.55 / $2,503.19	Professional		$2,023.55	$2,023.55	$2,503.19
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $267.48 / $267.48 / $296.55	Professional	26	$267.48	$267.48	$296.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,789.49 / $1,789.49 / $2,206.65	Professional	TC	$1,789.49	$1,789.49	$2,206.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $83.96 / $473.95 / $1,148.96	Professional		$83.96	$473.95	$1,148.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.81 / $63.51 / $142.32	Professional	26	$50.81	$63.51	$142.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $359.37 / $449.21 / $1,006.64	Professional	TC	$359.37	$449.21	$1,006.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $44.60 / $335.80 / $597.78	Professional		$44.60	$335.80	$597.78
Providence Facility/Professional Professional Modifier Low / Median / High Price $230.59 / $331.87 / $586.10	Professional		$230.59	$331.87	$586.10
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $31.36 / $47.44 / $74.48	Professional	26	$31.36	$47.44	$74.48
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $202.13 / $293.91 / $509.86	Professional	TC	$202.13	$293.91	$509.86
United Facility/Professional Professional Modifier Low / Median / High Price $216.45 / $309.87 / $505.05	Professional		$216.45	$309.87	$505.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.56 / $38.47 / $57.71	Professional	26	$31.56	$38.47	$57.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $184.56 / $273.48 / $455.81	Professional	TC	$184.56	$273.48	$455.81
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $245.15 / $272.81 / $390.11	Professional		$245.15	$272.81	$390.11
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.37 / $35.02 / $48.28	Professional	26	$30.37	$35.02	$48.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $214.78 / $237.80 / $341.83	Professional	TC	$214.78	$237.80	$341.83