Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.16 / $147.19 / $260.13	Professional		$92.16	$147.19	$260.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $14.57 / $17.63 / $47.49	Professional	26	$14.57	$17.63	$47.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.77 / $126.65 / $234.65	Professional	TC	$79.77	$126.65	$234.65
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.09 / $85.09 / $85.09	Professional		$85.09	$85.09	$85.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $10.69 / $10.69 / $25.62	Professional	26	$10.69	$10.69	$25.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $28.76 / $89.08 / $285.58	Professional		$28.76	$89.08	$285.58
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $125.39 / $198.00 / $270.67	Professional		$125.39	$198.00	$270.67
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $21.28 / $21.49 / $22.38	Professional	26	$21.28	$21.49	$22.38
Cigna Facility/Professional Professional Modifier Low / Median / High Price $76.79 / $111.59 / $338.15	Professional		$76.79	$111.59	$338.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $11.19 / $26.84 / $65.39	Professional	26	$11.19	$26.84	$65.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.41 / $92.73 / $290.57	Professional	TC	$55.41	$92.73	$290.57
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $128.05 / $240.51 / $240.51	Facility	26	$128.05	$240.51	$240.51
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,336.58 / $1,336.58 / $1,642.13	Professional		$1,336.58	$1,336.58	$1,642.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $262.83 / $315.72 / $315.72	Professional	26	$262.83	$315.72	$315.72
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,188.97 / $1,188.97 / $1,461.53	Professional	TC	$1,188.97	$1,188.97	$1,461.53
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $221.20 / $282.87 / $470.56	Professional		$221.20	$282.87	$470.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $27.50 / $33.00 / $52.54	Professional	26	$27.50	$33.00	$52.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $208.23 / $249.87 / $418.02	Professional	TC	$208.23	$249.87	$418.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $23.79 / $175.92 / $339.21	Professional		$23.79	$175.92	$339.21
Providence Facility/Professional Professional Modifier Low / Median / High Price $76.79 / $162.52 / $506.64	Professional		$76.79	$162.52	$506.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $11.19 / $26.02 / $65.39	Professional	26	$11.19	$26.02	$65.39
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.41 / $92.08 / $276.56	Professional	TC	$55.41	$92.08	$276.56
United Facility/Professional Professional Modifier Low / Median / High Price $93.85 / $127.12 / $365.94	Professional		$93.85	$127.12	$365.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $15.59 / $25.98 / $62.87	Professional	26	$15.59	$25.98	$62.87
United Facility/Professional Professional Modifier TC Low / Median / High Price $59.18 / $94.82 / $313.98	Professional	TC	$59.18	$94.82	$313.98
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $64.54 / $103.97 / $188.27	Professional		$64.54	$103.97	$188.27
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $10.13 / $20.29 / $22.14	Professional	26	$10.13	$20.29	$22.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $44.25 / $92.17 / $166.13	Professional	TC	$44.25	$92.17	$166.13