Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.71 / $63.17 / $96.86	Facility	26	$48.71	$63.17	$96.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $293.77 / $435.43 / $1,067.05	Professional		$293.77	$435.43	$1,067.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.71 / $75.08 / $168.04	Professional	26	$48.71	$75.08	$168.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $245.07 / $322.92 / $653.23	Professional	TC	$245.07	$322.92	$653.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $272.45 / $412.56 / $530.86	Professional		$272.45	$412.56	$530.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.72 / $78.50 / $138.51	Professional	26	$49.72	$78.50	$138.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $222.73 / $254.55 / $270.45	Professional	TC	$222.73	$254.55	$270.45
BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.11 / $355.54 / $455.02	Professional		$61.11	$355.54	$455.02
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $259.00 / $447.59 / $647.71	Professional		$259.00	$447.59	$647.71
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $70.30 / $78.86 / $78.86	Professional	26	$70.30	$78.86	$78.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $337.37 / $500.19 / $905.99	Professional		$337.37	$500.19	$905.99
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.13 / $90.76 / $148.66	Professional	26	$62.13	$90.76	$148.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $287.68 / $437.00 / $767.47	Professional	TC	$287.68	$437.00	$767.47
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $178.45 / $367.41 / $367.41	Facility	26	$178.45	$367.41	$367.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,898.56 / $2,898.56 / $3,550.05	Professional		$2,898.56	$2,898.56	$3,550.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $479.37 / $479.37 / $597.08	Professional	26	$479.37	$479.37	$597.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,419.25 / $2,419.25 / $2,952.98	Professional	TC	$2,419.25	$2,419.25	$2,952.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $133.16 / $720.04 / $1,755.00	Professional		$133.16	$720.04	$1,755.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.00 / $128.75 / $288.52	Professional	26	$103.00	$128.75	$288.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $480.85 / $601.05 / $1,346.92	Professional	TC	$480.85	$601.05	$1,346.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.85 / $404.40 / $778.06	Professional		$86.85	$404.40	$778.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $354.91 / $529.94 / $915.91	Professional		$354.91	$529.94	$915.91
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.50 / $95.66 / $148.66	Professional	26	$63.50	$95.66	$148.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $306.27 / $458.04 / $786.98	Professional	TC	$306.27	$458.04	$786.98
United Facility/Professional Professional Modifier Low / Median / High Price $387.74 / $503.42 / $823.96	Professional		$387.74	$503.42	$823.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.67 / $80.84 / $141.44	Professional	26	$64.67	$80.84	$141.44
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.07 / $426.83 / $666.33	Professional	TC	$323.07	$426.83	$666.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $348.95 / $389.21 / $555.42	Professional		$348.95	$389.21	$555.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $61.56 / $71.03 / $98.06	Professional	26	$61.56	$71.03	$98.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $287.39 / $318.18 / $457.37	Professional	TC	$287.39	$318.18	$457.37