Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $57.54 / $97.72	Facility	26	$48.98	$57.54	$97.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $323.59 / $436.52 / $1,096.48	Professional		$323.59	$436.52	$1,096.48
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $77.62 / $223.87	Professional	26	$58.88	$77.62	$223.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $263.03 / $354.81 / $724.44	Professional	TC	$263.03	$354.81	$724.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $275.42 / $389.05 / $537.03	Professional		$275.42	$389.05	$537.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $77.62 / $120.23	Professional	26	$56.23	$77.62	$120.23
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $234.42 / $281.84 / $630.96	Professional	TC	$234.42	$281.84	$630.96
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $331.13 / $457.09	Professional		$57.54	$331.13	$457.09
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $446.68 / $707.95	Professional		$181.97	$446.68	$707.95
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $77.62 / $77.62	Professional	26	$70.79	$77.62	$77.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $354.81 / $524.81 / $912.01	Professional		$354.81	$524.81	$912.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $93.33 / $151.36	Professional	26	$63.10	$93.33	$151.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $457.09 / $776.25	Professional	TC	$288.40	$457.09	$776.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $478.63 / $478.63 / $478.63	Facility	26	$478.63	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $645.65 / $3,548.13 / $3,548.13	Professional		$645.65	$3,548.13	$3,548.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $478.63 / $602.56 / $602.56	Professional	26	$478.63	$602.56	$602.56
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,398.83 / $2,951.21 / $2,951.21	Professional	TC	$2,398.83	$2,951.21	$2,951.21
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $61.66 / $100.00	Facility	26	$47.86	$61.66	$100.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $346.74 / $537.03 / $1,513.56	Professional		$346.74	$537.03	$1,513.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $87.10 / $218.78	Professional	26	$58.88	$87.10	$218.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $275.42 / $436.52 / $851.14	Professional	TC	$275.42	$436.52	$851.14
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $338.84	Professional		$32.36	$33.11	$338.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $489.78 / $912.01	Professional		$363.08	$489.78	$912.01
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $87.10 / $144.54	Professional	26	$63.10	$87.10	$144.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $288.40 / $436.52 / $776.25	Professional	TC	$288.40	$436.52	$776.25
United Facility/Professional Professional Modifier Low / Median / High Price $389.05 / $501.19 / $831.76	Professional		$389.05	$501.19	$831.76
United Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $81.28 / $144.54	Professional	26	$64.57	$81.28	$144.54
United Facility/Professional Professional Modifier TC Low / Median / High Price $323.59 / $426.58 / $691.83	Professional	TC	$323.59	$426.58	$691.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $407.38 / $407.38 / $426.58	Professional		$407.38	$407.38	$426.58
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $72.44 / $75.86	Professional	26	$72.44	$72.44	$75.86
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $338.84 / $338.84 / $354.81	Professional	TC	$338.84	$338.84	$354.81