Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.92 / $51.33 / $72.33	Facility	26	$42.92	$51.33	$72.33
Aetna Facility/Professional Professional Modifier Low / Median / High Price $296.76 / $366.53 / $542.78	Professional		$296.76	$366.53	$542.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.71 / $57.46 / $105.48	Professional	26	$47.71	$57.46	$105.48
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $251.27 / $310.17 / $438.61	Professional	TC	$251.27	$310.17	$438.61
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $337.08 / $357.09 / $435.05	Professional		$337.08	$357.09	$435.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.93 / $57.92 / $78.98	Professional	26	$50.93	$57.92	$78.98
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $304.44 / $304.44 / $338.60	Professional	TC	$304.44	$304.44	$338.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.17 / $271.36 / $506.22	Professional		$44.17	$271.36	$506.22
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $213.00 / $446.36 / $605.28	Professional		$213.00	$446.36	$605.28
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $52.16 / $77.83 / $77.83	Professional	26	$52.16	$77.83	$77.83
Cigna Facility/Professional Professional Modifier Low / Median / High Price $263.04 / $438.99 / $715.32	Professional		$263.04	$438.99	$715.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.38 / $72.68 / $110.82	Professional	26	$54.38	$72.68	$110.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $232.77 / $375.12 / $612.30	Professional	TC	$232.77	$375.12	$612.30
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.97 / $276.20 / $276.20	Facility	26	$128.97	$276.20	$276.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,452.27 / $2,452.27 / $3,270.00	Professional		$2,452.27	$2,452.27	$3,270.00
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $354.09 / $354.09 / $447.83	Professional	26	$354.09	$354.09	$447.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,098.17 / $2,098.17 / $2,822.18	Professional	TC	$2,098.17	$2,098.17	$2,822.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $80.48 / $479.23 / $757.64	Professional		$80.48	$479.23	$757.64
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $62.99 / $82.16 / $99.88	Professional	26	$62.99	$82.16	$99.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $370.50 / $492.92 / $599.24	Professional	TC	$370.50	$492.92	$599.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.55 / $387.05 / $708.03	Professional		$60.55	$387.05	$708.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $332.09 / $491.96 / $914.46	Professional		$332.09	$491.96	$914.46
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $55.08 / $74.55 / $110.54	Professional	26	$55.08	$74.55	$110.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $254.26 / $380.84 / $608.78	Professional	TC	$254.26	$380.84	$608.78
United Facility/Professional Professional Modifier Low / Median / High Price $269.58 / $371.72 / $575.60	Professional		$269.58	$371.72	$575.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.60 / $62.15 / $98.75	Professional	26	$44.60	$62.15	$98.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $218.39 / $312.52 / $480.27	Professional	TC	$218.39	$312.52	$480.27
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $320.79 / $375.32 / $510.71	Professional		$320.79	$375.32	$510.71
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.83 / $53.92 / $72.95	Professional	26	$45.83	$53.92	$72.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $274.95 / $321.39 / $437.75	Professional	TC	$274.95	$321.39	$437.75