Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.70 / $30.20 / $52.48	Facility	26	$25.70	$30.20	$52.48
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $263.03 / $537.03	Professional		$190.55	$263.03	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $44.67 / $120.23	Professional	26	$30.90	$44.67	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $223.87 / $398.11	Professional	TC	$162.18	$223.87	$398.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $208.93 / $446.68	Professional		$194.98	$208.93	$446.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $38.02 / $66.07	Professional	26	$29.51	$38.02	$66.07
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 $30.90 / $204.17 / $281.84	Professional		$30.90	$204.17	$281.84
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $181.97 / $302.00	Professional		$169.82	$181.97	$302.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $190.55 / $190.55	Professional	26	$37.15	$190.55	$190.55
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $295.12 / $524.81	Professional		$208.93	$295.12	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $50.12 / $87.10	Professional	26	$33.88	$50.12	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $245.47 / $426.58	Professional	TC	$173.78	$245.47	$426.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $251.19 / $251.19 / $251.19	Facility	26	$251.19	$251.19	$251.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,819.70 / $2,238.72 / $2,238.72	Professional		$1,819.70	$2,238.72	$2,238.72
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $331.13 / $331.13	Professional	26	$331.13	$331.13	$331.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,548.82 / $1,905.46 / $1,905.46	Professional	TC	$1,548.82	$1,905.46	$1,905.46
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $24.55 / $28.84 / $52.48	Facility	26	$24.55	$28.84	$52.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $354.81 / $776.25	Professional		$213.80	$354.81	$776.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $32.36 / $57.54 / $131.83	Professional	26	$32.36	$57.54	$131.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $186.21 / $295.12 / $660.69	Professional	TC	$186.21	$295.12	$660.69
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $213.80	Professional		$32.36	$33.11	$213.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $302.00 / $501.19	Professional		$208.93	$302.00	$501.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $47.86 / $79.43	Professional	26	$33.88	$47.86	$79.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $173.78 / $257.04 / $426.58	Professional	TC	$173.78	$257.04	$426.58
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $263.03 / $467.74	Professional		$204.17	$263.03	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $41.69 / $66.07	Professional	26	$34.67	$41.69	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.82 / $229.09 / $380.19	Professional	TC	$169.82	$229.09	$380.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $245.47 / $245.47 / $257.04	Professional		$245.47	$245.47	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $38.02 / $39.81	Professional	26	$38.02	$38.02	$39.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $218.78 / $218.78	Professional	TC	$218.78	$218.78	$218.78