Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $128.88 / $914.84	Facility	26	$100.00	$128.88	$914.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $188.22 / $227.84 / $377.06	Professional		$188.22	$227.84	$377.06
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $110.15 / $132.43 / $202.34	Professional	26	$110.15	$132.43	$202.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.94 / $89.52 / $132.84	Professional	TC	$74.94	$89.52	$132.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $193.90 / $224.62 / $263.48	Professional		$193.90	$224.62	$263.48
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $122.40 / $141.38 / $187.82	Professional	26	$122.40	$141.38	$187.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $102.53 / $168.65 / $278.77	Professional		$102.53	$168.65	$278.77
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $201.83 / $243.55 / $336.93	Professional		$201.83	$243.55	$336.93
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $121.27 / $181.12 / $181.12	Professional	26	$121.27	$181.12	$181.12
Cigna Facility/Professional Professional Modifier Low / Median / High Price $153.10 / $275.64 / $429.14	Professional		$153.10	$275.64	$429.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $127.75 / $169.38 / $262.66	Professional	26	$127.75	$169.38	$262.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $80.12 / $118.34 / $181.72	Professional	TC	$80.12	$118.34	$181.72
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $299.41 / $642.01 / $642.01	Facility	26	$299.41	$642.01	$642.01
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,374.92 / $1,374.92 / $1,714.13	Professional		$1,374.92	$1,374.92	$1,714.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $824.31 / $824.31 / $1,042.50	Professional	26	$824.31	$824.31	$1,042.50
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $550.61 / $550.61 / $671.63	Professional	TC	$550.61	$550.61	$671.63
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $216.29 / $322.64 / $487.30	Professional		$216.29	$322.64	$487.30
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $146.46 / $191.04 / $232.24	Professional	26	$146.46	$191.04	$232.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $89.92 / $117.29 / $142.59	Professional	TC	$89.92	$117.29	$142.59
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $86.84 / $165.65 / $353.20	Professional		$86.84	$165.65	$353.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $166.13 / $294.86 / $525.39	Professional		$166.13	$294.86	$525.39
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $128.52 / $174.86 / $262.66	Professional	26	$128.52	$174.86	$262.66
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $80.87 / $119.55 / $181.51	Professional	TC	$80.87	$119.55	$181.51
United Facility/Professional Professional Modifier Low / Median / High Price $186.09 / $245.93 / $393.38	Professional		$186.09	$245.93	$393.38
United Facility/Professional Professional Modifier 26 Low / Median / High Price $109.13 / $144.69 / $233.75	Professional	26	$109.13	$144.69	$233.75
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.38 / $102.60 / $164.72	Professional	TC	$77.38	$102.60	$164.72
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $171.99 / $201.83 / $273.77	Professional		$171.99	$201.83	$273.77
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $106.56 / $125.35 / $169.60	Professional	26	$106.56	$125.35	$169.60
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $65.43 / $76.48 / $104.17	Professional	TC	$65.43	$76.48	$104.17