Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.72 / $44.46 / $79.40	Facility	26	$40.72	$44.46	$79.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $84.67 / $137.58 / $711.27	Professional		$84.67	$137.58	$711.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $62.83 / $419.96	Professional	26	$40.72	$62.83	$419.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $43.40 / $62.00 / $150.81	Professional	TC	$43.40	$62.00	$150.81
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $94.55 / $124.35 / $165.45	Professional		$94.55	$124.35	$165.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $49.01 / $63.43 / $99.76	Professional	26	$49.01	$63.43	$99.76
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.83 / $101.75 / $163.46	Professional		$48.83	$101.75	$163.46
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $123.72 / $148.46 / $204.93	Professional		$123.72	$148.46	$204.93
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $57.14 / $61.20 / $61.20	Professional	26	$57.14	$61.20	$61.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $107.33 / $161.66 / $280.94	Professional		$107.33	$161.66	$280.94
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.02 / $70.45 / $118.77	Professional	26	$52.02	$70.45	$118.77
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $56.09 / $86.77 / $164.79	Professional	TC	$56.09	$86.77	$164.79
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $141.46 / $347.58 / $347.58	Facility	26	$141.46	$347.58	$347.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,049.00 / $1,067.26 / $1,067.26	Professional		$1,049.00	$1,067.26	$1,067.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $716.57 / $855.01 / $855.01	Professional	26	$716.57	$855.01	$855.01
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $724.87 / $746.61 / $746.61	Professional	TC	$724.87	$746.61	$746.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $84.59 / $186.73 / $277.16	Professional		$84.59	$186.73	$277.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.53 / $97.14 / $134.00	Professional	26	$76.53	$97.14	$134.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.27 / $105.68 / $143.15	Professional	TC	$83.27	$105.68	$143.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.31 / $103.44 / $216.51	Professional		$66.31	$103.44	$216.51
Providence Facility/Professional Professional Modifier Low / Median / High Price $108.91 / $161.66 / $285.25	Professional		$108.91	$161.66	$285.25
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.02 / $69.20 / $118.77	Professional	26	$52.02	$69.20	$118.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.09 / $90.28 / $167.64	Professional	TC	$56.09	$90.28	$167.64
United Facility/Professional Professional Modifier Low / Median / High Price $117.25 / $177.09 / $240.74	Professional		$117.25	$177.09	$240.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.32 / $73.42 / $103.62	Professional	26	$53.32	$73.42	$103.62
United Facility/Professional Professional Modifier TC Low / Median / High Price $60.73 / $94.47 / $139.74	Professional	TC	$60.73	$94.47	$139.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $104.91 / $118.18 / $167.02	Professional		$104.91	$118.18	$167.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $50.24 / $57.66 / $80.00	Professional	26	$50.24	$57.66	$80.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $54.66 / $60.52 / $87.01	Professional	TC	$54.66	$60.52	$87.01