Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.38 / $38.33 / $61.30	Facility	26	$28.38	$38.33	$61.30
Aetna Facility/Professional Professional Modifier Low / Median / High Price $102.48 / $144.81 / $263.87	Professional		$102.48	$144.81	$263.87
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.36 / $45.11 / $79.15	Professional	26	$31.36	$45.11	$79.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $66.76 / $101.32 / $173.76	Professional	TC	$66.76	$101.32	$173.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.79 / $105.64 / $129.18	Professional		$87.79	$105.64	$129.18
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.60 / $41.69 / $52.98	Professional	26	$32.60	$41.69	$52.98
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.68 / $100.26 / $215.75	Professional		$38.68	$100.26	$215.75
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $125.42 / $144.07 / $145.01	Professional		$125.42	$144.07	$145.01
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $39.93 / $39.93 / $42.59	Professional	26	$39.93	$39.93	$42.59
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.81 / $187.82 / $317.57	Professional		$134.81	$187.82	$317.57
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.90 / $60.52 / $96.24	Professional	26	$44.90	$60.52	$96.24
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $92.95 / $125.60 / $216.37	Professional	TC	$92.95	$125.60	$216.37
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $109.00 / $214.35 / $214.35	Facility	26	$109.00	$214.35	$214.35
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,086.26 / $1,086.26 / $1,129.05	Professional		$1,086.26	$1,086.26	$1,129.05
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $449.09 / $449.09 / $449.09	Professional	26	$449.09	$449.09	$449.09
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $867.64 / $893.67 / $893.67	Professional	TC	$867.64	$893.67	$893.67
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.42 / $196.50 / $524.00	Professional		$125.42	$196.50	$524.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.56 / $66.23 / $98.23	Professional	26	$48.56	$66.23	$98.23
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.10 / $143.36 / $217.76	Professional	TC	$105.10	$143.36	$217.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $46.62 / $121.26 / $236.48	Professional		$46.62	$121.26	$236.48
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $49.06 / $49.06 / $49.06	Facility	26	$49.06	$49.06	$49.06
Providence Facility/Professional Professional Modifier Low / Median / High Price $132.38 / $190.00 / $331.36	Professional		$132.38	$190.00	$331.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.36 / $60.15 / $92.59	Professional	26	$44.36	$60.15	$92.59
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $91.26 / $122.01 / $203.09	Professional	TC	$91.26	$122.01	$203.09
United Facility/Professional Professional Modifier Low / Median / High Price $109.08 / $151.52 / $282.01	Professional		$109.08	$151.52	$282.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $36.76 / $48.50 / $80.83	Professional	26	$36.76	$48.50	$80.83
United Facility/Professional Professional Modifier TC Low / Median / High Price $73.48 / $102.70 / $205.20	Professional	TC	$73.48	$102.70	$205.20
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.80 / $125.42 / $177.97	Professional		$111.80	$125.42	$177.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $35.33 / $40.75 / $57.05	Professional	26	$35.33	$40.75	$57.05
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $76.47 / $84.66 / $121.69	Professional	TC	$76.47	$84.66	$121.69