Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.52 / $34.72 / $61.60	Facility	26	$28.52	$34.72	$61.60
Aetna Facility/Professional Professional Modifier Low / Median / High Price $159.81 / $194.90 / $363.24	Professional		$159.81	$194.90	$363.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $21.51 / $35.56 / $57.26	Professional	26	$21.51	$35.56	$57.26
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $129.12 / $162.49 / $275.93	Professional	TC	$129.12	$162.49	$275.93
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $127.21 / $154.52 / $231.78	Professional		$127.21	$154.52	$231.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $28.51 / $36.29 / $66.02	Professional	26	$28.51	$36.29	$66.02
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.17 / $139.24 / $266.91	Professional		$32.17	$139.24	$266.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $181.73 / $270.77 / $308.94	Professional		$181.73	$270.77	$308.94
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $35.27 / $39.21 / $39.21	Professional	26	$35.27	$39.21	$39.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.28 / $43.28 / $43.28	Facility	26	$43.28	$43.28	$43.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $185.37 / $268.05 / $442.98	Professional		$185.37	$268.05	$442.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.58 / $41.22 / $71.34	Professional	26	$26.58	$41.22	$71.34
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $154.86 / $224.34 / $393.79	Professional	TC	$154.86	$224.34	$393.79
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $87.53 / $181.36 / $181.36	Facility	26	$87.53	$181.36	$181.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,546.49 / $1,588.86 / $1,662.38	Professional		$1,546.49	$1,588.86	$1,662.38
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $391.31 / $391.31 / $391.31	Professional	26	$391.31	$391.31	$391.31
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,356.90 / $1,417.87 / $1,456.72	Professional	TC	$1,356.90	$1,417.87	$1,456.72
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $57.88 / $286.26 / $414.61	Professional		$57.88	$286.26	$414.61
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.50 / $57.97 / $86.04	Professional	26	$42.50	$57.97	$86.04
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $181.37 / $247.39 / $363.97	Professional	TC	$181.37	$247.39	$363.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.38 / $175.32 / $249.88	Professional		$42.38	$175.32	$249.88
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.28 / $43.28 / $43.28	Facility	26	$43.28	$43.28	$43.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $189.64 / $275.67 / $470.02	Professional		$189.64	$275.67	$470.02
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $26.53 / $41.07 / $66.64	Professional	26	$26.53	$41.07	$66.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $155.61 / $224.10 / $381.50	Professional	TC	$155.61	$224.10	$381.50
United Facility/Professional Professional Modifier Low / Median / High Price $170.43 / $238.32 / $393.88	Professional		$170.43	$238.32	$393.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $22.81 / $38.68 / $61.71	Professional	26	$22.81	$38.68	$61.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $139.59 / $203.11 / $331.48	Professional	TC	$139.59	$203.11	$331.48
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.88 / $181.73 / $258.95	Professional		$162.88	$181.73	$258.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.92 / $35.63 / $49.88	Professional	26	$30.92	$35.63	$49.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $131.96 / $146.10 / $209.97	Professional	TC	$131.96	$146.10	$209.97