Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.23 / $78.18 / $109.37	Facility	26	$65.23	$78.18	$109.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $335.55 / $412.07 / $585.41	Professional		$335.55	$412.07	$585.41
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $71.79 / $87.91 / $155.16	Professional	26	$71.79	$87.91	$155.16
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $267.24 / $327.18 / $463.17	Professional	TC	$267.24	$327.18	$463.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $380.47 / $409.11 / $470.98	Professional		$380.47	$409.11	$470.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $73.37 / $91.27 / $109.12	Professional	26	$73.37	$91.27	$109.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.95 / $312.95 / $582.92	Professional		$75.95	$312.95	$582.92
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $314.50 / $500.00 / $756.85	Professional		$314.50	$500.00	$756.85
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $78.86 / $118.10 / $118.10	Professional	26	$78.86	$118.10	$118.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $330.87 / $517.50 / $835.28	Professional		$330.87	$517.50	$835.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.37 / $112.72 / $169.39	Professional	26	$83.37	$112.72	$169.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $256.22 / $408.12 / $684.82	Professional	TC	$256.22	$408.12	$684.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $194.95 / $417.76 / $417.76	Facility	26	$194.95	$417.76	$417.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,747.80 / $2,747.80 / $3,731.33	Professional		$2,747.80	$2,747.80	$3,731.33
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $677.18 / $774.69 / $774.69	Professional	26	$677.18	$774.69	$774.69
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,208.88 / $2,208.88 / $3,054.08	Professional	TC	$2,208.88	$2,208.88	$3,054.08
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $310.80 / $657.73 / $949.22	Professional		$310.80	$657.73	$949.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.24 / $124.22 / $151.01	Professional	26	$95.24	$124.22	$151.01
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $409.03 / $533.51 / $648.58	Professional	TC	$409.03	$533.51	$648.58
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.73 / $430.15 / $803.44	Professional		$93.73	$430.15	$803.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $380.47 / $570.27 / $1,089.27	Professional		$380.47	$570.27	$1,089.27
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $85.72 / $115.57 / $168.50	Professional	26	$85.72	$115.57	$168.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $295.88 / $418.15 / $688.34	Professional	TC	$295.88	$418.15	$688.34
United Facility/Professional Professional Modifier Low / Median / High Price $310.77 / $437.67 / $676.02	Professional		$310.77	$437.67	$676.02
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.76 / $94.35 / $152.76	Professional	26	$71.76	$94.35	$152.76
United Facility/Professional Professional Modifier TC Low / Median / High Price $245.22 / $339.39 / $524.94	Professional	TC	$245.22	$339.39	$524.94
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $366.89 / $429.40 / $584.12	Professional		$366.89	$429.40	$584.12
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $81.53 / $110.32	Professional	26	$69.29	$81.53	$110.32
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $297.60 / $347.87 / $473.81	Professional	TC	$297.60	$347.87	$473.81