Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $28.87 / $34.61 / $62.36	Facility	26	$28.87	$34.61	$62.36
Aetna Facility/Professional Professional Modifier Low / Median / High Price $119.44 / $190.44 / $710.25	Professional		$119.44	$190.44	$710.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.33 / $50.50 / $157.04	Professional	26	$31.33	$50.50	$157.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $87.05 / $123.06 / $262.12	Professional	TC	$87.05	$123.06	$262.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.19 / $117.25 / $272.35	Professional		$102.19	$117.25	$272.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $27.83 / $35.64 / $69.51	Professional	26	$27.83	$35.64	$69.51
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $88.27 / $98.48 / $98.48	Professional	TC	$88.27	$98.48	$98.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.49 / $101.52 / $194.61	Professional		$32.49	$101.52	$194.61
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $136.19 / $194.00 / $276.98	Professional		$136.19	$194.00	$276.98
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $35.28 / $35.95 / $36.61	Professional	26	$35.28	$35.95	$36.61
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $43.24	Facility	26	$43.24	$43.24	$43.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.65 / $223.25 / $386.65	Professional		$153.65	$223.25	$386.65
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $58.06 / $105.83	Professional	26	$37.43	$58.06	$105.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.52 / $166.44 / $289.86	Professional	TC	$117.52	$166.44	$289.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $103.49 / $251.76 / $251.76	Facility	26	$103.49	$251.76	$251.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,241.41 / $1,354.08 / $1,391.18	Professional		$1,241.41	$1,354.08	$1,391.18
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $315.36 / $335.64 / $344.84	Professional	26	$315.36	$335.64	$344.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $934.20 / $1,018.44 / $1,046.33	Professional	TC	$934.20	$1,018.44	$1,046.33
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $56.63 / $198.90 / $304.00	Professional		$56.63	$198.90	$304.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $42.50 / $57.97 / $85.27	Professional	26	$42.50	$57.97	$85.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.97 / $186.83 / $276.39	Professional	TC	$136.97	$186.83	$276.39
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.88 / $144.33 / $280.52	Professional		$41.88	$144.33	$280.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $43.24 / $43.24 / $43.24	Facility	26	$43.24	$43.24	$43.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $154.26 / $230.52 / $404.58	Professional		$154.26	$230.52	$404.58
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $37.43 / $57.24 / $105.26	Professional	26	$37.43	$57.24	$105.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.55 / $165.94 / $268.98	Professional	TC	$117.55	$165.94	$268.98
United Facility/Professional Professional Modifier Low / Median / High Price $137.88 / $196.77 / $340.46	Professional		$137.88	$196.77	$340.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $32.63 / $49.30 / $88.85	Professional	26	$32.63	$49.30	$88.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $101.34 / $145.68 / $248.09	Professional	TC	$101.34	$145.68	$248.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $121.75 / $136.19 / $193.67	Professional		$121.75	$136.19	$193.67
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $30.92 / $35.64 / $49.90	Professional	26	$30.92	$35.64	$49.90
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $90.83 / $100.56 / $144.50	Professional	TC	$90.83	$100.56	$144.50