Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $77.04 / $90.39 / $113.51	Facility	26	$77.04	$90.39	$113.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $230.90 / $279.04 / $408.69	Professional		$230.90	$279.04	$408.69
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $83.34 / $100.76 / $139.71	Professional	26	$83.34	$100.76	$139.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $137.56 / $176.03 / $282.43	Professional	TC	$137.56	$176.03	$282.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $250.85 / $269.73 / $285.91	Professional		$250.85	$269.73	$285.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.75 / $201.51 / $373.76	Professional		$89.75	$201.51	$373.76
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $281.67 / $338.00 / $470.22	Professional		$281.67	$338.00	$470.22
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $93.69 / $100.04 / $100.04	Professional	26	$93.69	$100.04	$100.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.03 / $362.11 / $645.00	Professional		$245.03	$362.11	$645.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $99.11 / $130.44 / $198.84	Professional	26	$99.11	$130.44	$198.84
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.08 / $227.63 / $475.56	Professional	TC	$144.08	$227.63	$475.56
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $232.57 / $495.05 / $495.05	Facility	26	$232.57	$495.05	$495.05
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,013.87 / $2,013.87 / $2,428.35	Professional		$2,013.87	$2,013.87	$2,428.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $716.57 / $716.57 / $802.73	Professional	26	$716.57	$716.57	$802.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,590.04 / $1,590.04 / $1,625.63	Professional	TC	$1,590.04	$1,590.04	$1,625.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $260.80 / $400.16 / $848.78	Professional		$260.80	$400.16	$848.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $113.07 / $147.47 / $179.29	Professional	26	$113.07	$147.47	$179.29
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $217.42 / $283.58 / $344.75	Professional	TC	$217.42	$283.58	$344.75
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $109.03 / $251.13 / $496.12	Professional		$109.03	$251.13	$496.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $273.00 / $391.47 / $717.09	Professional		$273.00	$391.47	$717.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $99.85 / $134.55 / $198.43	Professional	26	$99.85	$134.55	$198.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $160.07 / $227.82 / $474.35	Professional	TC	$160.07	$227.82	$474.35
United Facility/Professional Professional Modifier Low / Median / High Price $220.59 / $309.33 / $483.34	Professional		$220.59	$309.33	$483.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $82.78 / $111.41 / $177.01	Professional	26	$82.78	$111.41	$177.01
United Facility/Professional Professional Modifier TC Low / Median / High Price $131.91 / $193.37 / $329.98	Professional	TC	$131.91	$193.37	$329.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $240.46 / $281.67 / $382.73	Professional		$240.46	$281.67	$382.73
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $82.27 / $96.82 / $130.99	Professional	26	$82.27	$96.82	$130.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $158.19 / $184.85 / $251.73	Professional	TC	$158.19	$184.85	$251.73