Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.79 / $61.56 / $96.75	Facility	26	$44.79	$61.56	$96.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $140.33 / $214.06 / $645.26	Professional		$140.33	$214.06	$645.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.88 / $72.52 / $317.00	Professional	26	$54.88	$72.52	$317.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.24 / $132.93 / $216.62	Professional	TC	$85.24	$132.93	$216.62
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $166.26 / $169.78 / $228.09	Professional		$166.26	$169.78	$228.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $59.83 / $70.80 / $96.50	Professional	26	$59.83	$70.80	$96.50
BCBS Facility/Professional Professional Modifier Low / Median / High Price $60.74 / $147.72 / $292.24	Professional		$60.74	$147.72	$292.24
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $169.78 / $230.11 / $346.00	Professional		$169.78	$230.11	$346.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $63.67 / $96.35 / $96.35	Professional	26	$63.67	$96.35	$96.35
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Cigna Facility/Professional Professional Modifier Low / Median / High Price $183.98 / $252.52 / $405.89	Professional		$183.98	$252.52	$405.89
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.73 / $94.90 / $152.25	Professional	26	$70.73	$94.90	$152.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $115.02 / $159.49 / $259.27	Professional	TC	$115.02	$159.49	$259.27
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $187.00 / $557.91 / $557.91	Facility	26	$187.00	$557.91	$557.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,518.68 / $1,677.02 / $1,677.02	Professional		$1,518.68	$1,677.02	$1,677.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $718.23 / $718.23 / $718.23	Professional	26	$718.23	$718.23	$718.23
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $978.30 / $985.97 / $985.97	Professional	TC	$978.30	$985.97	$985.97
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $115.44 / $265.41 / $318.49	Professional		$115.44	$265.41	$318.49
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.68 / $99.97 / $121.53	Professional	26	$81.68	$99.97	$121.53
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $139.50 / $178.56 / $270.72	Professional	TC	$139.50	$178.56	$270.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $73.98 / $152.37 / $319.18	Professional		$73.98	$152.37	$319.18
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $78.01 / $78.01 / $78.01	Facility	26	$78.01	$78.01	$78.01
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.42 / $256.58 / $465.15	Professional		$186.42	$256.58	$465.15
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.91 / $94.32 / $145.51	Professional	26	$69.91	$94.32	$145.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.80 / $158.41 / $252.08	Professional	TC	$117.80	$158.41	$252.08
United Facility/Professional Professional Modifier Low / Median / High Price $159.03 / $217.98 / $359.36	Professional		$159.03	$217.98	$359.36
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.27 / $77.95 / $130.63	Professional	26	$58.27	$77.95	$130.63
United Facility/Professional Professional Modifier TC Low / Median / High Price $102.45 / $138.62 / $228.40	Professional	TC	$102.45	$138.62	$228.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.01 / $169.78 / $240.45	Professional		$151.01	$169.78	$240.45
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $55.77 / $64.33 / $90.06	Professional	26	$55.77	$64.33	$90.06
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.25 / $105.45 / $151.59	Professional	TC	$95.25	$105.45	$151.59