Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $119.28 / $142.34 / $199.38	Facility	26	$119.28	$142.34	$199.38
Aetna Facility/Professional Professional Modifier Low / Median / High Price $220.53 / $258.33 / $439.83	Professional		$220.53	$258.33	$439.83
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $132.22 / $156.75 / $219.71	Professional	26	$132.22	$156.75	$219.71
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $78.73 / $99.72 / $143.44	Professional	TC	$78.73	$99.72	$143.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $207.72 / $251.08 / $295.36	Professional		$207.72	$251.08	$295.36
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $135.12 / $171.05 / $197.70	Professional	26	$135.12	$171.05	$197.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $122.87 / $197.29 / $326.12	Professional		$122.87	$197.29	$326.12
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $235.16 / $295.36 / $420.32	Professional		$235.16	$295.36	$420.32
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $145.15 / $215.84 / $215.84	Professional	26	$145.15	$215.84	$215.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $178.01 / $318.39 / $499.46	Professional		$178.01	$318.39	$499.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $152.96 / $203.15 / $312.04	Professional	26	$152.96	$203.15	$312.04
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.64 / $129.58 / $200.88	Professional	TC	$89.64	$129.58	$200.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $358.27 / $767.41 / $767.41	Facility	26	$358.27	$767.41	$767.41
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,600.14 / $1,600.14 / $1,997.93	Professional		$1,600.14	$1,600.14	$1,997.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $982.86 / $982.86 / $1,248.83	Professional	26	$982.86	$982.86	$1,248.83
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $617.27 / $617.27 / $749.18	Professional	TC	$617.27	$617.27	$749.18
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $266.67 / $410.97 / $567.25	Professional		$266.67	$410.97	$567.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $175.29 / $228.64 / $277.95	Professional	26	$175.29	$228.64	$277.95
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.16 / $130.65 / $158.83	Professional	TC	$100.16	$130.65	$158.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $96.11 / $198.46 / $411.53	Professional		$96.11	$198.46	$411.53
Providence Facility/Professional Professional Modifier Low / Median / High Price $194.63 / $343.16 / $610.08	Professional		$194.63	$343.16	$610.08
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $152.96 / $208.38 / $312.04	Professional	26	$152.96	$208.38	$312.04
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $90.21 / $132.00 / $198.81	Professional	TC	$90.21	$132.00	$198.81
United Facility/Professional Professional Modifier Low / Median / High Price $214.31 / $287.18 / $467.87	Professional		$214.31	$287.18	$467.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $131.04 / $172.56 / $283.33	Professional	26	$131.04	$172.56	$283.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.44 / $111.60 / $177.41	Professional	TC	$83.44	$111.60	$177.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $200.43 / $235.16 / $318.92	Professional		$200.43	$235.16	$318.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $127.54 / $150.00 / $202.95	Professional	26	$127.54	$150.00	$202.95
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $72.88 / $85.16 / $115.98	Professional	TC	$72.88	$85.16	$115.98