Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.29 / $75.73 / $132.57	Facility	26	$69.29	$75.73	$132.57
Aetna Facility/Professional Professional Modifier Low / Median / High Price $236.23 / $296.58 / $590.40	Professional		$236.23	$296.58	$590.40
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $90.30 / $163.77	Professional	26	$69.29	$90.30	$163.77
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $165.42 / $204.15 / $372.70	Professional	TC	$165.42	$204.15	$372.70
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $388.89 / $388.89 / $388.89	Professional		$388.89	$388.89	$388.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $98.20 / $107.97 / $122.63	Professional	26	$98.20	$107.97	$122.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $124.64 / $275.07 / $419.55	Professional		$124.64	$275.07	$419.55
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $324.08 / $377.23 / $522.91	Professional		$324.08	$377.23	$522.91
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $97.32 / $100.62 / $103.47	Professional	26	$97.32	$100.62	$103.47
Cigna Facility/Professional Professional Modifier Low / Median / High Price $292.45 / $388.73 / $635.67	Professional		$292.45	$388.73	$635.67
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $87.71 / $117.84 / $196.47	Professional	26	$87.71	$117.84	$196.47
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $197.14 / $270.70 / $442.35	Professional	TC	$197.14	$270.70	$442.35
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $240.70 / $517.75 / $517.75	Facility	26	$240.70	$517.75	$517.75
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,193.48 / $2,193.48 / $2,933.78	Professional		$2,193.48	$2,193.48	$2,933.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $640.52 / $640.52 / $837.45	Professional	26	$640.52	$640.52	$837.45
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,552.95 / $1,552.95 / $2,096.33	Professional	TC	$1,552.95	$1,552.95	$2,096.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $324.08 / $559.86 / $774.36	Professional		$324.08	$559.86	$774.36
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $130.35 / $165.45 / $228.43	Professional	26	$130.35	$165.45	$228.43
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $310.75 / $394.42 / $545.92	Professional	TC	$310.75	$394.42	$545.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $121.08 / $316.95 / $562.10	Professional		$121.08	$316.95	$562.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $281.70 / $388.89 / $652.54	Professional		$281.70	$388.89	$652.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $87.95 / $117.52 / $196.47	Professional	26	$87.95	$117.52	$196.47
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $190.47 / $266.19 / $446.51	Professional	TC	$190.47	$266.19	$446.51
United Facility/Professional Professional Modifier Low / Median / High Price $274.57 / $417.59 / $539.11	Professional		$274.57	$417.59	$539.11
United Facility/Professional Professional Modifier 26 Low / Median / High Price $84.88 / $128.18 / $166.66	Professional	26	$84.88	$128.18	$166.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $196.57 / $286.23 / $372.45	Professional	TC	$196.57	$286.23	$372.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $289.58 / $324.08 / $460.94	Professional		$289.58	$324.08	$460.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.58 / $98.20 / $136.26	Professional	26	$85.58	$98.20	$136.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $204.01 / $225.88 / $324.68	Professional	TC	$204.01	$225.88	$324.68