Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.97 / $54.96 / $87.94	Facility	26	$39.97	$54.96	$87.94
Aetna Facility/Professional Professional Modifier Low / Median / High Price $180.68 / $233.84 / $901.00	Professional		$180.68	$233.84	$901.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.29 / $69.18 / $268.00	Professional	26	$50.29	$69.18	$268.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.52 / $157.32 / $284.26	Professional	TC	$120.52	$157.32	$284.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $139.61 / $169.53 / $209.97	Professional		$139.61	$169.53	$209.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.11 / $48.72 / $68.30	Professional	26	$40.11	$48.72	$68.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.22 / $156.31 / $299.64	Professional		$52.22	$156.31	$299.64
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $120.00 / $309.14 / $557.33	Professional		$120.00	$309.14	$557.33
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.73 / $61.33 / $61.33	Professional	26	$56.73	$61.33	$61.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $218.02 / $288.68 / $456.34	Professional		$218.02	$288.68	$456.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.16 / $84.54 / $134.22	Professional	26	$63.16	$84.54	$134.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $157.16 / $204.76 / $340.16	Professional	TC	$157.16	$204.76	$340.16
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $143.07 / $296.77 / $314.00	Facility	26	$143.07	$296.77	$314.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,442.20 / $1,442.20 / $1,800.98	Professional		$1,442.20	$1,442.20	$1,800.98
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $482.10 / $507.29 / $507.29	Professional	26	$482.10	$507.29	$507.29
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,055.58 / $1,055.58 / $1,318.88	Professional	TC	$1,055.58	$1,055.58	$1,318.88
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $102.18 / $292.08 / $470.09	Professional		$102.18	$292.08	$470.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.78 / $93.15 / $232.88	Professional	26	$72.78	$93.15	$232.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $176.43 / $240.66 / $370.81	Professional	TC	$176.43	$240.66	$370.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $65.08 / $198.98 / $374.60	Professional		$65.08	$198.98	$374.60
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.50 / $69.50 / $69.50	Facility	26	$69.50	$69.50	$69.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $217.01 / $296.60 / $493.62	Professional		$217.01	$296.60	$493.62
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $62.36 / $84.49 / $129.16	Professional	26	$62.36	$84.49	$129.16
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $156.99 / $204.84 / $309.94	Professional	TC	$156.99	$204.84	$309.94
United Facility/Professional Professional Modifier Low / Median / High Price $184.95 / $249.34 / $415.94	Professional		$184.95	$249.34	$415.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.58 / $68.59 / $111.04	Professional	26	$51.58	$68.59	$111.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.82 / $174.82 / $289.80	Professional	TC	$130.82	$174.82	$289.80
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $178.06 / $199.45 / $283.45	Professional		$178.06	$199.45	$283.45
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.69 / $57.32 / $80.25	Professional	26	$49.69	$57.32	$80.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $128.37 / $142.13 / $204.31	Professional	TC	$128.37	$142.13	$204.31