Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $37.60 / $46.99 / $60.97	Facility	26	$37.60	$46.99	$60.97
Aetna Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $145.97 / $275.00	Professional		$109.44	$145.97	$275.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.59 / $48.23 / $86.00	Professional	26	$39.59	$48.23	$86.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.61 / $96.83 / $171.90	Professional	TC	$68.61	$96.83	$171.90
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $36.28 / $56.63 / $83.24	Professional	26	$36.28	$56.63	$83.24
BCBS Facility/Professional Professional Modifier Low / Median / High Price $37.07 / $96.45 / $152.47	Professional		$37.07	$96.45	$152.47
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $129.51 / $197.41 / $246.76	Professional		$129.51	$197.41	$246.76
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $42.24 / $46.05	Professional	26	$42.24	$42.24	$46.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.72 / $186.37 / $321.45	Professional		$110.72	$186.37	$321.45
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $52.82 / $94.88	Professional	26	$34.67	$52.82	$94.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.91 / $121.68 / $226.36	Professional	TC	$72.91	$121.68	$226.36
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $327.27 / $411.36 / $422.56	Facility	26	$327.27	$411.36	$422.56
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,035.22 / $1,055.73 / $1,108.95	Professional		$1,035.22	$1,055.73	$1,108.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $287.12 / $287.12 / $360.98	Professional	26	$287.12	$287.12	$360.98
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $780.77 / $803.30 / $803.30	Professional	TC	$780.77	$803.30	$803.30
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.38 / $204.54 / $312.18	Professional		$123.38	$204.54	$312.18
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.34 / $71.51 / $173.36	Professional	26	$56.34	$71.51	$173.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $111.01 / $140.88 / $209.40	Professional	TC	$111.01	$140.88	$209.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $55.67 / $158.05 / $328.54	Professional		$55.67	$158.05	$328.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $51.84 / $51.84 / $51.84	Facility	26	$51.84	$51.84	$51.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $114.39 / $208.39 / $368.38	Professional		$114.39	$208.39	$368.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.50 / $49.41 / $92.81	Professional	26	$37.50	$49.41	$92.81
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.91 / $120.24 / $224.26	Professional	TC	$72.91	$120.24	$224.26
United Facility/Professional Professional Modifier Low / Median / High Price $124.85 / $170.82 / $280.64	Professional		$124.85	$170.82	$280.64
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.61 / $49.44 / $84.92	Professional	26	$39.61	$49.44	$84.92
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.43 / $113.42 / $194.88	Professional	TC	$82.43	$113.42	$194.88
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.88 / $123.38 / $174.84	Professional		$109.88	$123.38	$174.84
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.99 / $42.69 / $58.81	Professional	26	$36.99	$42.69	$58.81
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $72.88 / $85.19 / $1,100.00	Professional	TC	$72.88	$85.19	$1,100.00