Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.34 / $39.33 / $61.20	Facility	26	$30.34	$39.33	$61.20
Aetna Facility/Professional Professional Modifier Low / Median / High Price $214.52 / $275.18 / $536.29	Professional		$214.52	$275.18	$536.29
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.14 / $45.24 / $213.36	Professional	26	$33.14	$45.24	$213.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $184.18 / $235.85 / $455.86	Professional	TC	$184.18	$235.85	$455.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $397.91 / $397.91 / $397.91	Professional		$397.91	$397.91	$397.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.92 / $44.90 / $107.76	Professional	26	$35.92	$44.90	$107.76
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.25 / $238.28 / $340.42	Professional		$39.25	$238.28	$340.42
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $220.00 / $220.00 / $357.58	Professional		$220.00	$220.00	$357.58
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.44 / $45.58 / $50.36	Professional	26	$44.44	$45.58	$50.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $246.30 / $351.16 / $661.74	Professional		$246.30	$351.16	$661.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.64 / $58.58 / $96.56	Professional	26	$39.64	$58.58	$96.56
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $207.95 / $302.41 / $561.55	Professional	TC	$207.95	$302.41	$561.55
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $112.48 / $231.75 / $231.75	Facility	26	$112.48	$231.75	$231.75
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,116.12 / $2,116.12 / $2,616.38	Professional		$2,116.12	$2,116.12	$2,616.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $350.03 / $350.03 / $378.60	Professional	26	$350.03	$350.03	$378.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,817.68 / $1,817.68 / $2,237.78	Professional	TC	$1,817.68	$1,817.68	$2,237.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $286.06 / $496.35 / $745.43	Professional		$286.06	$496.35	$745.43
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.13 / $81.41 / $182.44	Professional	26	$65.13	$81.41	$182.44
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $364.44 / $455.55 / $1,020.84	Professional	TC	$364.44	$455.55	$1,020.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.12 / $326.18 / $604.55	Professional		$56.12	$326.18	$604.55
Providence Facility/Professional Professional Modifier Low / Median / High Price $257.77 / $360.44 / $670.90	Professional		$257.77	$360.44	$670.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.44 / $62.05 / $96.99	Professional	26	$40.44	$62.05	$96.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $221.23 / $324.70 / $579.40	Professional	TC	$221.23	$324.70	$579.40
United Facility/Professional Professional Modifier Low / Median / High Price $259.29 / $355.35 / $536.48	Professional		$259.29	$355.35	$536.48
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.29 / $49.74 / $76.80	Professional	26	$41.29	$49.74	$76.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $217.74 / $306.04 / $459.06	Professional	TC	$217.74	$306.04	$459.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $256.74 / $286.06 / $408.62	Professional		$256.74	$286.06	$408.62
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.93 / $44.90 / $61.95	Professional	26	$38.93	$44.90	$61.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $217.81 / $241.16 / $346.67	Professional	TC	$217.81	$241.16	$346.67