Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.69 / $73.87 / $103.26	Facility	26	$61.69	$73.87	$103.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.08 / $158.63 / $234.55	Professional		$130.08	$158.63	$234.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.64 / $81.97 / $111.17	Professional	26	$66.64	$81.97	$111.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $55.03 / $79.09 / $110.23	Professional	TC	$55.03	$79.09	$110.23
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $215.91 / $215.91 / $215.91	Professional		$215.91	$215.91	$215.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $75.16 / $75.16 / $77.86	Professional	26	$75.16	$75.16	$77.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $63.44 / $123.43 / $211.96	Professional		$63.44	$123.43	$211.96
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $150.38 / $201.52 / $266.29	Professional		$150.38	$201.52	$266.29
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $74.47 / $111.86 / $111.86	Professional	26	$74.47	$111.86	$111.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.79 / $196.27 / $321.62	Professional		$117.79	$196.27	$321.62
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $78.92 / $103.59 / $161.00	Professional	26	$78.92	$103.59	$161.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.47 / $98.09 / $158.78	Professional	TC	$54.47	$98.09	$158.78
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $183.99 / $394.16 / $394.16	Facility	26	$183.99	$394.16	$394.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,053.48 / $1,053.48 / $1,277.48	Professional		$1,053.48	$1,053.48	$1,277.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $509.36 / $509.36 / $639.83	Professional	26	$509.36	$509.36	$639.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $544.05 / $544.05 / $637.65	Professional	TC	$544.05	$544.05	$637.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $143.94 / $261.52 / $373.10	Professional		$143.94	$261.52	$373.10
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $89.92 / $117.29 / $142.59	Professional	26	$89.92	$117.29	$142.59
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.37 / $111.35 / $135.37	Professional	TC	$85.37	$111.35	$135.37
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.08 / $128.05 / $266.29	Professional		$77.08	$128.05	$266.29
Providence Facility/Professional Professional Modifier Low / Median / High Price $121.09 / $208.11 / $395.14	Professional		$121.09	$208.11	$395.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $79.01 / $107.14 / $158.90	Professional	26	$79.01	$107.14	$158.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $58.50 / $100.69 / $160.34	Professional	TC	$58.50	$100.69	$160.34
United Facility/Professional Professional Modifier Low / Median / High Price $125.60 / $175.76 / $282.45	Professional		$125.60	$175.76	$282.45
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.27 / $89.30 / $142.10	Professional	26	$65.27	$89.30	$142.10
United Facility/Professional Professional Modifier TC Low / Median / High Price $50.56 / $85.29 / $140.40	Professional	TC	$50.56	$85.29	$140.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $127.54 / $149.57 / $203.03	Professional		$127.54	$149.57	$203.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $65.43 / $76.97 / $104.14	Professional	26	$65.43	$76.97	$104.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $62.12 / $72.59 / $98.89	Professional	TC	$62.12	$72.59	$98.89