Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $69.15 / $85.68 / $174.16	Professional		$69.15	$85.68	$174.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.04 / $69.17 / $135.47	Professional	26	$53.04	$69.17	$135.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $16.11 / $21.35 / $77.93	Professional	TC	$16.11	$21.35	$77.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $36.61 / $113.46 / $191.35	Professional		$36.61	$113.46	$191.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.00 / $120.50 / $160.35	Professional		$63.00	$120.50	$160.35
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $76.73 / $125.50 / $180.00	Professional		$76.73	$125.50	$180.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $80.23 / $81.28 / $83.69	Professional	26	$80.23	$81.28	$83.69
Cigna Facility/Professional Professional Modifier Low / Median / High Price $56.36 / $76.27 / $216.50	Professional		$56.36	$76.27	$216.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.92 / $53.30 / $152.31	Professional	26	$40.92	$53.30	$152.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $13.28 / $27.95 / $65.67	Professional	TC	$13.28	$27.95	$65.67
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $209.02 / $429.02 / $429.02	Facility	26	$209.02	$429.02	$429.02
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $745.14 / $745.14 / $943.13	Professional		$745.14	$745.14	$943.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $538.00 / $538.00 / $687.38	Professional	26	$538.00	$538.00	$687.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $340.13 / $340.13 / $340.13	Professional	TC	$340.13	$340.13	$340.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $139.46 / $168.86 / $251.26	Professional		$139.46	$168.86	$251.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $104.31 / $133.52 / $191.11	Professional	26	$104.31	$133.52	$191.11
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $36.39 / $43.67 / $60.15	Professional	TC	$36.39	$43.67	$60.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $29.65 / $93.08 / $200.45	Professional		$29.65	$93.08	$200.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $56.97 / $108.69 / $281.08	Professional		$56.97	$108.69	$281.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $40.99 / $53.30 / $157.00	Professional	26	$40.99	$53.30	$157.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $13.20 / $27.95 / $72.42	Professional	TC	$13.20	$27.95	$72.42
United Facility/Professional Professional Modifier Low / Median / High Price $70.59 / $84.43 / $256.04	Professional		$70.59	$84.43	$256.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.57 / $54.86 / $181.90	Professional	26	$49.57	$54.86	$181.90
United Facility/Professional Professional Modifier TC Low / Median / High Price $16.02 / $30.50 / $64.61	Professional	TC	$16.02	$30.50	$64.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $45.88 / $59.73 / $113.02	Professional		$45.88	$59.73	$113.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.47 / $44.43 / $83.99	Professional	26	$35.47	$44.43	$83.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $10.42 / $22.33 / $29.02	Professional	TC	$10.42	$22.33	$29.02