Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.41 / $55.38 / $70.83	Facility	26	$44.41	$55.38	$70.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $133.12 / $181.85 / $370.52	Professional		$133.12	$181.85	$370.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.15 / $55.38 / $147.15	Professional	26	$46.15	$55.38	$147.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $86.43 / $119.60 / $239.98	Professional	TC	$86.43	$119.60	$239.98
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $118.37 / $140.15 / $194.95	Professional		$118.37	$140.15	$194.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $50.59 / $98.66	Professional	26	$40.47	$50.59	$98.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.02 / $124.48 / $188.81	Professional		$44.02	$124.48	$188.81
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $147.08 / $210.23 / $246.00	Professional		$147.08	$210.23	$246.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $50.08 / $54.11	Professional	26	$50.08	$50.08	$54.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $125.19 / $214.68 / $420.64	Professional		$125.19	$214.68	$420.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.45 / $61.51 / $111.71	Professional	26	$40.45	$61.51	$111.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.00 / $146.40 / $307.77	Professional	TC	$81.00	$146.40	$307.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $388.00 / $488.64 / $502.08	Facility	26	$388.00	$488.64	$502.08
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,547.04 / $1,593.45 / $1,593.45	Professional		$1,547.04	$1,593.45	$1,593.45
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.24 / $363.24 / $428.03	Professional	26	$363.24	$363.24	$428.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,263.33 / $1,301.23 / $1,301.23	Professional	TC	$1,263.33	$1,301.23	$1,301.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $140.15 / $241.25 / $574.90	Professional		$140.15	$241.25	$574.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $84.86 / $205.72	Professional	26	$66.86	$84.86	$205.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.21 / $156.38 / $379.12	Professional	TC	$123.21	$156.38	$379.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.15 / $114.49 / $245.01	Professional		$57.15	$114.49	$245.01
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.71 / $237.67 / $437.00	Professional		$128.71	$237.67	$437.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.25 / $57.56 / $108.56	Professional	26	$44.25	$57.56	$108.56
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $81.02 / $144.76 / $311.37	Professional	TC	$81.02	$144.76	$311.37
United Facility/Professional Professional Modifier Low / Median / High Price $140.80 / $198.78 / $362.58	Professional		$140.80	$198.78	$362.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.39 / $57.74 / $101.05	Professional	26	$46.39	$57.74	$101.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.33 / $129.49 / $231.64	Professional	TC	$86.33	$129.49	$231.64
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $124.79 / $140.15 / $198.56	Professional		$124.79	$140.15	$198.56
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.89 / $50.59 / $69.84	Professional	26	$43.89	$50.59	$69.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $80.89 / $94.52 / $1,100.00	Professional	TC	$80.89	$94.52	$1,100.00