Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.73 / $65.94 / $116.06	Facility	26	$53.73	$65.94	$116.06
Aetna Facility/Professional Professional Modifier Low / Median / High Price $188.67 / $258.29 / $973.00	Professional		$188.67	$258.29	$973.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.94 / $88.47 / $256.44	Professional	26	$65.94	$88.47	$256.44
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.66 / $160.69 / $260.18	Professional	TC	$107.66	$160.69	$260.18
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.45 / $223.95 / $277.41	Professional		$198.45	$223.95	$277.41
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $71.67 / $71.67 / $140.07	Professional	26	$71.67	$71.67	$140.07
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.78 / $164.38 / $315.11	Professional		$64.78	$164.38	$315.11
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $234.73 / $266.74 / $342.64	Professional		$234.73	$266.74	$342.64
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $76.28 / $115.43 / $115.43	Professional	26	$76.28	$115.43	$115.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $236.27 / $317.23 / $506.66	Professional		$236.27	$317.23	$506.66
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $84.83 / $115.03 / $188.57	Professional	26	$84.83	$115.03	$188.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $198.18 / $322.50	Professional	TC	$152.47	$198.18	$322.50
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $192.51 / $399.24 / $399.24	Facility	26	$192.51	$399.24	$399.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,380.40 / $2,380.40 / $2,380.40	Professional		$2,380.40	$2,380.40	$2,380.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $520.19 / $520.19 / $647.63	Professional	26	$520.19	$520.19	$647.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $982.86 / $982.86 / $1,266.38	Professional	TC	$982.86	$982.86	$1,266.38
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $158.69 / $340.49 / $454.26	Professional		$158.69	$340.49	$454.26
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $97.85 / $119.77 / $145.60	Professional	26	$97.85	$119.77	$145.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $180.34 / $220.73 / $268.33	Professional	TC	$180.34	$220.73	$268.33
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $87.77 / $195.95 / $400.61	Professional		$87.77	$195.95	$400.61
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.46 / $93.46 / $93.46	Facility	26	$93.46	$93.46	$93.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $236.27 / $327.72 / $537.47	Professional		$236.27	$327.72	$537.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $83.78 / $113.69 / $170.78	Professional	26	$83.78	$113.69	$170.78
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $152.47 / $196.67 / $295.17	Professional	TC	$152.47	$196.67	$295.17
United Facility/Professional Professional Modifier Low / Median / High Price $194.15 / $271.81 / $457.60	Professional		$194.15	$271.81	$457.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $69.88 / $96.08 / $163.81	Professional	26	$69.88	$96.08	$163.81
United Facility/Professional Professional Modifier TC Low / Median / High Price $124.17 / $172.39 / $280.85	Professional	TC	$124.17	$172.39	$280.85
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $189.93 / $213.39 / $302.33	Professional		$189.93	$213.39	$302.33
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.81 / $77.06 / $107.90	Professional	26	$66.81	$77.06	$107.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $123.13 / $136.32 / $195.90	Professional	TC	$123.13	$136.32	$195.90