Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.45 / $96.18 / $134.68	Facility	26	$80.45	$96.18	$134.68
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.63 / $187.60 / $296.24	Professional		$156.63	$187.60	$296.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $88.25 / $106.15 / $168.31	Professional	26	$88.25	$106.15	$168.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $65.51 / $78.01 / $116.01	Professional	TC	$65.51	$78.01	$116.01
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $153.63 / $194.32 / $243.26	Professional		$153.63	$194.32	$243.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $97.99 / $113.20 / $132.28	Professional	26	$97.99	$113.20	$132.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $82.18 / $139.74 / $230.99	Professional		$82.18	$139.74	$230.99
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $170.28 / $210.82 / $290.88	Professional		$170.28	$210.82	$290.88
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $97.08 / $146.15 / $146.15	Professional	26	$97.08	$146.15	$146.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.18 / $228.62 / $365.30	Professional		$135.18	$228.62	$365.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $102.40 / $135.58 / $210.54	Professional	26	$102.40	$135.58	$210.54
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.93 / $103.32 / $157.97	Professional	TC	$70.93	$103.32	$157.97
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $239.95 / $514.76 / $514.76	Facility	26	$239.95	$514.76	$514.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,142.65 / $1,142.65 / $1,428.60	Professional		$1,142.65	$1,142.65	$1,428.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $663.65 / $663.65 / $833.40	Professional	26	$663.65	$663.65	$833.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $479.00 / $479.00 / $595.20	Professional	TC	$479.00	$479.00	$595.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $179.75 / $293.07 / $428.40	Professional		$179.75	$293.07	$428.40
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $117.24 / $152.91 / $185.91	Professional	26	$117.24	$152.91	$185.91
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.68 / $103.93 / $126.35	Professional	TC	$79.68	$103.93	$126.35
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.92 / $137.88 / $295.50	Professional		$77.92	$137.88	$295.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $137.52 / $244.28 / $435.75	Professional		$137.52	$244.28	$435.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $102.89 / $140.56 / $210.54	Professional	26	$102.89	$140.56	$210.54
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.68 / $104.11 / $156.19	Professional	TC	$71.68	$104.11	$156.19
United Facility/Professional Professional Modifier Low / Median / High Price $152.04 / $205.39 / $332.54	Professional		$152.04	$205.39	$332.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $88.24 / $116.72 / $191.50	Professional	26	$88.24	$116.72	$191.50
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.56 / $92.38 / $146.62	Professional	TC	$67.56	$92.38	$146.62
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $143.28 / $168.14 / $228.12	Professional		$143.28	$168.14	$228.12
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $85.30 / $100.37 / $135.82	Professional	26	$85.30	$100.37	$135.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $57.98 / $67.76 / $92.29	Professional	TC	$57.98	$67.76	$92.29