Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.24 / $72.05 / $101.14	Facility	26	$60.24	$72.05	$101.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.54 / $144.97 / $238.75	Professional		$118.54	$144.97	$238.75
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.89 / $79.87 / $125.30	Professional	26	$65.89	$79.87	$125.30
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $51.19 / $61.31 / $90.28	Professional	TC	$51.19	$61.31	$90.28
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.30 / $133.13 / $186.00	Professional		$112.30	$133.13	$186.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.78 / $76.00 / $98.80	Professional	26	$67.78	$76.00	$98.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $61.84 / $106.81 / $176.56	Professional		$61.84	$106.81	$176.56
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $129.26 / $155.11 / $214.69	Professional		$129.26	$155.11	$214.69
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $72.89 / $109.24 / $109.24	Professional	26	$72.89	$109.24	$109.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.45 / $175.04 / $272.60	Professional		$114.45	$175.04	$272.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $76.67 / $101.37 / $157.72	Professional	26	$76.67	$101.37	$157.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.79 / $79.65 / $122.82	Professional	TC	$54.79	$79.65	$122.82
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $180.18 / $386.70 / $386.70	Facility	26	$180.18	$386.70	$386.70
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $874.03 / $874.03 / $1,093.34	Professional		$874.03	$874.03	$1,093.34
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $497.06 / $497.06 / $625.42	Professional	26	$497.06	$497.06	$625.42
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $376.97 / $376.97 / $467.93	Professional	TC	$376.97	$376.97	$467.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $147.68 / $224.74 / $378.90	Professional		$147.68	$224.74	$378.90
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.02 / $114.81 / $139.57	Professional	26	$88.02	$114.81	$139.57
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $62.60 / $81.66 / $99.27	Professional	TC	$62.60	$81.66	$99.27
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.30 / $105.60 / $226.03	Professional		$61.30	$105.60	$226.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $117.60 / $186.34 / $333.66	Professional		$117.60	$186.34	$333.66
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $77.25 / $105.35 / $157.72	Professional	26	$77.25	$105.35	$157.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.35 / $80.93 / $121.17	Professional	TC	$56.35	$80.93	$121.17
United Facility/Professional Professional Modifier Low / Median / High Price $115.83 / $156.12 / $252.77	Professional		$115.83	$156.12	$252.77
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.30 / $87.16 / $143.00	Professional	26	$65.30	$87.16	$143.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $52.07 / $69.54 / $111.65	Professional	TC	$52.07	$69.54	$111.65
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.60 / $128.60 / $174.50	Professional		$109.60	$128.60	$174.50
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $64.04 / $75.37 / $101.99	Professional	26	$64.04	$75.37	$101.99
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $45.55 / $53.23 / $72.50	Professional	TC	$45.55	$53.23	$72.50