Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.17 / $88.94 / $92.23	Facility	26	$57.17	$88.94	$92.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $393.75 / $642.90	Professional		$250.00	$393.75	$642.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $97.27 / $154.00	Professional	26	$62.50	$97.27	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $187.50 / $281.37 / $433.05	Professional	TC	$187.50	$281.37	$433.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $196.98 / $196.98 / $406.26	Professional		$196.98	$196.98	$406.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.88 / $92.61 / $135.05	Professional	26	$65.88	$92.61	$135.05
BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.65 / $202.58 / $319.83	Professional		$59.65	$202.58	$319.83
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $226.00 / $257.60 / $615.54	Professional		$226.00	$257.60	$615.54
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $65.20 / $65.20 / $70.53	Professional	26	$65.20	$65.20	$70.53
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Cigna Facility/Professional Professional Modifier Low / Median / High Price $221.56 / $385.32 / $758.16	Professional		$221.56	$385.32	$758.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.47 / $84.10 / $150.12	Professional	26	$54.47	$84.10	$150.12
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.04 / $296.60 / $592.09	Professional	TC	$163.04	$296.60	$592.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $505.36 / $635.84 / $653.60	Facility	26	$505.36	$635.84	$653.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,872.81 / $2,958.99 / $2,958.99	Professional		$2,872.81	$2,958.99	$2,958.99
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $548.98 / $548.98 / $557.63	Professional	26	$548.98	$548.98	$557.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,498.98 / $2,573.94 / $2,573.94	Professional	TC	$2,498.98	$2,573.94	$2,573.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $322.25 / $425.37 / $780.00	Professional		$322.25	$425.37	$780.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.05 / $110.48 / $267.83	Professional	26	$87.05	$110.48	$267.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $248.09 / $314.89 / $763.36	Professional	TC	$248.09	$314.89	$763.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $111.51 / $717.40 / $785.70	Professional		$111.51	$717.40	$785.70
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.91 / $79.91 / $79.91	Facility	26	$79.91	$79.91	$79.91
Providence Facility/Professional Professional Modifier Low / Median / High Price $233.14 / $422.85 / $775.26	Professional		$233.14	$422.85	$775.26
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.31 / $84.10 / $150.00	Professional	26	$58.31	$84.10	$150.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $168.85 / $287.29 / $584.95	Professional	TC	$168.85	$287.29	$584.95
United Facility/Professional Professional Modifier Low / Median / High Price $250.61 / $375.91 / $684.85	Professional		$250.61	$375.91	$684.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.20 / $75.19 / $128.84	Professional	26	$60.20	$75.19	$128.84
United Facility/Professional Professional Modifier TC Low / Median / High Price $196.31 / $286.45 / $547.13	Professional	TC	$196.31	$286.45	$547.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $220.02 / $246.22 / $350.16	Professional		$220.02	$246.22	$350.16
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.15 / $65.88 / $90.88	Professional	26	$57.15	$65.88	$90.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.88 / $190.37 / $1,400.00	Professional	TC	$162.88	$190.37	$1,400.00