Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.54 / $49.67 / $85.41	Facility	26	$39.54	$49.67	$85.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $77.76 / $106.01 / $176.18	Professional		$77.76	$106.01	$176.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.41 / $62.96 / $97.54	Professional	26	$48.41	$62.96	$97.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $30.35 / $41.38 / $65.95	Professional	TC	$30.35	$41.38	$65.95
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.16 / $107.82 / $126.85	Professional		$95.16	$107.82	$126.85
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $54.61 / $58.32 / $77.51	Professional	26	$54.61	$58.32	$77.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.39 / $92.25 / $144.59	Professional		$52.39	$92.25	$144.59
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $107.20 / $137.69 / $215.68	Professional		$107.20	$137.69	$215.68
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.87 / $56.87 / $58.41	Professional	26	$56.87	$56.87	$58.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $96.39 / $130.40 / $210.75	Professional		$96.39	$130.40	$210.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.09 / $82.16 / $138.12	Professional	26	$60.09	$82.16	$138.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $31.49 / $46.65 / $78.48	Professional	TC	$31.49	$46.65	$78.48
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $140.60 / $284.70 / $294.26	Facility	26	$140.60	$284.70	$294.26
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $865.60 / $865.60 / $865.60	Professional		$865.60	$865.60	$865.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $382.35 / $382.35 / $477.60	Professional	26	$382.35	$382.35	$477.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $307.58 / $307.58 / $380.25	Professional	TC	$307.58	$307.58	$380.25
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $116.06 / $141.29 / $196.79	Professional		$116.06	$141.29	$196.79
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.54 / $80.61 / $112.28	Professional	26	$67.54	$80.61	$112.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $50.84 / $60.68 / $80.61	Professional	TC	$50.84	$60.68	$80.61
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.88 / $104.20 / $187.30	Professional		$53.88	$104.20	$187.30
Providence Facility/Professional Professional Modifier Low / Median / High Price $98.03 / $133.02 / $234.35	Professional		$98.03	$133.02	$234.35
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.11 / $81.89 / $128.03	Professional	26	$60.11	$81.89	$128.03
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $31.39 / $45.88 / $75.68	Professional	TC	$31.39	$45.88	$75.68
United Facility/Professional Professional Modifier Low / Median / High Price $74.87 / $99.38 / $157.97	Professional		$74.87	$99.38	$157.97
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.72 / $67.56 / $108.16	Professional	26	$48.72	$67.56	$108.16
United Facility/Professional Professional Modifier TC Low / Median / High Price $23.06 / $32.81 / $55.89	Professional	TC	$23.06	$32.81	$55.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $86.13 / $97.58 / $137.13	Professional		$86.13	$97.58	$137.13
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.14 / $56.62 / $78.26	Professional	26	$49.14	$56.62	$78.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $36.99 / $40.96 / $58.87	Professional	TC	$36.99	$40.96	$58.87