Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.48 / $72.00 / $89.28	Facility	26	$57.48	$72.00	$89.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.68 / $152.49 / $300.00	Professional		$120.68	$152.49	$300.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.40 / $70.88 / $151.72	Professional	26	$51.40	$70.88	$151.72
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $61.79 / $81.14 / $160.22	Professional	TC	$61.79	$81.14	$160.22
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.84 / $118.18 / $118.18	Professional		$102.84	$118.18	$118.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.49 / $73.20 / $127.94	Professional	26	$52.49	$73.20	$127.94
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.74 / $115.67 / $167.30	Professional		$56.74	$115.67	$167.30
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $118.18 / $177.27 / $236.36	Professional		$118.18	$177.27	$236.36
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $63.63 / $64.93 / $70.50	Professional	26	$63.63	$64.93	$70.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $104.36 / $157.29 / $368.96	Professional		$104.36	$157.29	$368.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.54 / $65.97 / $124.11	Professional	26	$48.54	$65.97	$124.11
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $48.28 / $83.38 / $254.43	Professional	TC	$48.28	$83.38	$254.43
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $503.20 / $632.16 / $646.64	Facility	26	$503.20	$632.16	$646.64
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,406.40 / $1,448.59 / $1,448.59	Professional		$1,406.40	$1,448.59	$1,448.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $439.49 / $439.49 / $555.45	Professional	26	$439.49	$439.49	$555.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,140.03 / $1,174.23 / $1,174.23	Professional	TC	$1,140.03	$1,174.23	$1,174.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $118.18 / $183.41 / $489.08	Professional		$118.18	$183.41	$489.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.62 / $106.61 / $266.52	Professional	26	$86.62	$106.61	$266.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $72.33 / $89.02 / $222.56	Professional	TC	$72.33	$89.02	$222.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $55.21 / $101.03 / $236.20	Professional		$55.21	$101.03	$236.20
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Providence Facility/Professional Professional Modifier Low / Median / High Price $105.70 / $172.91 / $381.86	Professional		$105.70	$172.91	$381.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.65 / $66.06 / $123.15	Professional	26	$47.65	$66.06	$123.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $47.63 / $81.58 / $209.12	Professional	TC	$47.63	$81.58	$209.12
United Facility/Professional Professional Modifier Low / Median / High Price $115.42 / $153.74 / $298.08	Professional		$115.42	$153.74	$298.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.35 / $68.23 / $119.05	Professional	26	$47.35	$68.23	$119.05
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.58 / $80.56 / $177.48	Professional	TC	$60.58	$80.56	$177.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.35 / $118.18 / $165.97	Professional		$104.35	$118.18	$165.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.87 / $65.61 / $90.40	Professional	26	$56.87	$65.61	$90.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $47.49 / $52.57 / $75.56	Professional	TC	$47.49	$52.57	$75.56