Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.47 / $33.96 / $64.56	Facility	26	$33.47	$33.96	$64.56
Aetna Facility/Professional Professional Modifier Low / Median / High Price $63.60 / $91.39 / $222.75	Professional		$63.60	$91.39	$222.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.71 / $45.55 / $106.79	Professional	26	$33.71	$45.55	$106.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $29.52 / $42.17 / $89.64	Professional	TC	$29.52	$42.17	$89.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $97.72 / $124.74	Professional		$97.72	$97.72	$124.74
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.27 / $38.27 / $63.14	Professional	26	$38.27	$38.27	$63.14
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.76 / $83.81 / $128.10	Professional		$44.76	$83.81	$128.10
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $89.10 / $103.71 / $142.82	Professional		$89.10	$103.71	$142.82
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $47.40 / $50.91 / $50.91	Professional	26	$47.40	$50.91	$50.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $78.93 / $114.31 / $222.11	Professional		$78.93	$114.31	$222.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.41 / $57.33 / $96.34	Professional	26	$42.41	$57.33	$96.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $37.96 / $57.14 / $119.40	Professional	TC	$37.96	$57.14	$119.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $117.07 / $262.14 / $262.14	Facility	26	$117.07	$262.14	$262.14
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,141.00 / $1,173.03 / $1,173.03	Professional		$1,141.00	$1,173.03	$1,173.03
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $493.68 / $493.68 / $493.68	Professional	26	$493.68	$493.68	$493.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $900.73 / $927.75 / $927.75	Professional	TC	$900.73	$927.75	$927.75
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $89.10 / $152.63 / $208.63	Professional		$89.10	$152.63	$208.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.49 / $80.59 / $111.17	Professional	26	$63.49	$80.59	$111.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.77 / $72.06 / $97.46	Professional	TC	$56.77	$72.06	$97.46
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $49.79 / $77.28 / $162.00	Professional		$49.79	$77.28	$162.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $80.56 / $116.32 / $224.00	Professional		$80.56	$116.32	$224.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.27 / $57.33 / $97.93	Professional	26	$43.27	$57.33	$97.93
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $37.96 / $57.80 / $119.40	Professional	TC	$37.96	$57.80	$119.40
United Facility/Professional Professional Modifier Low / Median / High Price $84.43 / $122.96 / $193.44	Professional		$84.43	$122.96	$193.44
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.97 / $56.84 / $88.96	Professional	26	$41.97	$56.84	$88.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $37.72 / $57.71 / $134.06	Professional	TC	$37.72	$57.71	$134.06
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $78.95 / $89.10 / $125.64	Professional		$78.95	$89.10	$125.64
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.68 / $47.83 / $66.34	Professional	26	$41.68	$47.83	$66.34
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $37.27 / $41.26 / $59.31	Professional	TC	$37.27	$41.26	$59.31