Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.54 / $43.52 / $69.05	Facility	26	$33.54	$43.52	$69.05
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.94 / $191.60 / $316.08	Professional		$147.94	$191.60	$316.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.14 / $46.99 / $78.73	Professional	26	$36.14	$46.99	$78.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.33 / $142.01 / $218.55	Professional	TC	$111.33	$142.01	$218.55
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $75.16 / $158.22 / $167.84	Professional		$75.16	$158.22	$167.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.32 / $49.32 / $84.71	Professional	26	$49.32	$49.32	$84.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.92 / $156.13 / $234.05	Professional		$42.92	$156.13	$234.05
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $124.49 / $206.23 / $301.83	Professional		$124.49	$206.23	$301.83
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.82 / $48.82 / $52.73	Professional	26	$48.82	$48.82	$52.73
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Cigna Facility/Professional Professional Modifier Low / Median / High Price $168.51 / $259.25 / $500.00	Professional		$168.51	$259.25	$500.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.43 / $59.19 / $108.08	Professional	26	$39.43	$59.19	$108.08
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $124.87 / $186.86 / $342.15	Professional	TC	$124.87	$186.86	$342.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $122.98 / $254.79 / $254.79	Facility	26	$122.98	$254.79	$254.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,374.92 / $1,374.92 / $1,698.38	Professional		$1,374.92	$1,374.92	$1,698.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $330.16 / $330.16 / $417.45	Professional	26	$330.16	$330.16	$417.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,044.76 / $1,044.76 / $1,280.93	Professional	TC	$1,044.76	$1,044.76	$1,280.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $250.33 / $339.34 / $611.15	Professional		$250.33	$339.34	$611.15
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $65.18 / $82.73 / $200.56	Professional	26	$65.18	$82.73	$200.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $190.07 / $241.25 / $584.84	Professional	TC	$190.07	$241.25	$584.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $52.23 / $202.54 / $361.53	Professional		$52.23	$202.54	$361.53
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $59.80 / $59.80 / $59.80	Facility	26	$59.80	$59.80	$59.80
Providence Facility/Professional Professional Modifier Low / Median / High Price $176.48 / $293.20 / $572.34	Professional		$176.48	$293.20	$572.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.92 / $57.11 / $106.82	Professional	26	$41.92	$57.11	$106.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $124.87 / $182.83 / $334.22	Professional	TC	$124.87	$182.83	$334.22
United Facility/Professional Professional Modifier Low / Median / High Price $190.77 / $236.03 / $429.75	Professional		$190.77	$236.03	$429.75
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.62 / $57.02 / $108.34	Professional	26	$45.62	$57.02	$108.34
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.51 / $179.01 / $339.19	Professional	TC	$143.51	$179.01	$339.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $167.57 / $187.48 / $266.72	Professional		$167.57	$187.48	$266.72
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.79 / $49.32 / $68.06	Professional	26	$42.79	$49.32	$68.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $124.79 / $145.85 / $1,400.00	Professional	TC	$124.79	$145.85	$1,400.00