Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.38 / $85.32 / $108.74	Facility	26	$68.38	$85.32	$108.74
Aetna Facility/Professional Professional Modifier Low / Median / High Price $203.45 / $264.62 / $426.19	Professional		$203.45	$264.62	$426.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.38 / $84.87 / $142.03	Professional	26	$68.38	$84.87	$142.03
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $130.51 / $179.39 / $262.08	Professional	TC	$130.51	$179.39	$262.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.33 / $75.33 / $150.65	Professional		$75.33	$75.33	$150.65
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.14 / $93.20 / $186.42	Professional	26	$62.14	$93.20	$186.42
BCBS Facility/Professional Professional Modifier Low / Median / High Price $73.59 / $174.34 / $295.23	Professional		$73.59	$174.34	$295.23
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $224.46 / $322.83 / $430.44	Professional		$224.46	$322.83	$430.44
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $76.88 / $81.76 / $84.26	Professional	26	$76.88	$81.76	$84.26
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.84 / $93.84 / $93.84	Facility	26	$93.84	$93.84	$93.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $192.19 / $286.25 / $546.97	Professional		$192.19	$286.25	$546.97
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.10 / $92.54 / $168.50	Professional	26	$62.10	$92.54	$168.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.24 / $194.38 / $381.50	Professional	TC	$124.24	$194.38	$381.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $595.28 / $750.32 / $768.32	Facility	26	$595.28	$750.32	$768.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,515.48 / $1,515.48 / $1,932.15	Professional		$1,515.48	$1,515.48	$1,932.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $521.79 / $521.79 / $655.65	Professional	26	$521.79	$521.79	$655.65
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $993.68 / $993.68 / $1,276.50	Professional	TC	$993.68	$993.68	$1,276.50
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $263.32 / $370.39 / $536.03	Professional		$263.32	$370.39	$536.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.61 / $130.22 / $315.72	Professional	26	$102.61	$130.22	$315.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $189.23 / $240.17 / $582.24	Professional	TC	$189.23	$240.17	$582.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $92.23 / $203.82 / $414.36	Professional		$92.23	$203.82	$414.36
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.84 / $93.84 / $93.84	Facility	26	$93.84	$93.84	$93.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.24 / $322.82 / $632.54	Professional		$199.24	$322.82	$632.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.02 / $87.64 / $163.15	Professional	26	$66.02	$87.64	$163.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $124.43 / $189.99 / $381.50	Professional	TC	$124.43	$189.99	$381.50
United Facility/Professional Professional Modifier Low / Median / High Price $218.16 / $276.33 / $478.49	Professional		$218.16	$276.33	$478.49
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.38 / $88.78 / $151.63	Professional	26	$70.38	$88.78	$151.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $139.58 / $195.84 / $302.94	Professional	TC	$139.58	$195.84	$302.94
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $191.59 / $215.22 / $304.91	Professional		$191.59	$215.22	$304.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.36 / $77.67 / $107.20	Professional	26	$67.36	$77.67	$107.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $124.23 / $145.16 / $1,100.00	Professional	TC	$124.23	$145.16	$1,100.00