Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.89 / $112.12 / $197.55	Facility	26	$101.89	$112.12	$197.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $193.12 / $267.22 / $545.74	Professional		$193.12	$267.22	$545.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.64 / $137.63 / $268.63	Professional	26	$102.64	$137.63	$268.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $89.40 / $123.37 / $238.86	Professional	TC	$89.40	$123.37	$238.86
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $299.25 / $305.75 / $382.02	Professional		$299.25	$305.75	$382.02
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $117.07 / $146.33 / $175.60	Professional	26	$117.07	$146.33	$175.60
BCBS Facility/Professional Professional Modifier Low / Median / High Price $139.21 / $259.19 / $390.71	Professional		$139.21	$259.19	$390.71
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $272.87 / $291.35 / $435.04	Professional		$272.87	$291.35	$435.04
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $145.02 / $153.54 / $153.54	Professional	26	$145.02	$153.54	$153.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $245.34 / $327.44 / $545.74	Professional		$245.34	$327.44	$545.74
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $129.34 / $175.52 / $291.98	Professional	26	$129.34	$175.52	$291.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $113.43 / $151.84 / $254.11	Professional	TC	$113.43	$151.84	$254.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $357.82 / $769.74 / $769.74	Facility	26	$357.82	$769.74	$769.74
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,788.06 / $1,788.06 / $2,427.08	Professional		$1,788.06	$1,788.06	$2,427.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $948.42 / $948.42 / $1,251.23	Professional	26	$948.42	$948.42	$1,251.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $839.64 / $839.64 / $1,175.84	Professional	TC	$839.64	$839.64	$1,175.84
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $202.28 / $467.54 / $844.50	Professional		$202.28	$467.54	$844.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $194.27 / $246.58 / $338.07	Professional	26	$194.27	$246.58	$338.07
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $174.08 / $220.95 / $295.44	Professional	TC	$174.08	$220.95	$295.44
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $152.04 / $235.27 / $496.39	Professional		$152.04	$235.27	$496.39
Providence Facility/Professional Professional Modifier Low / Median / High Price $245.34 / $330.59 / $574.00	Professional		$245.34	$330.59	$574.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $130.51 / $175.52 / $292.67	Professional	26	$130.51	$175.52	$292.67
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $113.43 / $151.84 / $254.11	Professional	TC	$113.43	$151.84	$254.11
United Facility/Professional Professional Modifier Low / Median / High Price $242.20 / $367.35 / $478.66	Professional		$242.20	$367.35	$478.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.19 / $194.04 / $256.51	Professional	26	$131.19	$194.04	$256.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.86 / $173.22 / $217.68	Professional	TC	$110.86	$173.22	$217.68
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $241.84 / $272.87 / $384.75	Professional		$241.84	$272.87	$384.75
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $127.54 / $146.33 / $202.93	Professional	26	$127.54	$146.33	$202.93
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $114.29 / $126.53 / $181.82	Professional	TC	$114.29	$126.53	$181.82