Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.20 / $40.54 / $58.54	Facility	26	$33.20	$40.54	$58.54
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.15 / $135.72 / $335.00	Professional		$95.15	$135.72	$335.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $34.75 / $43.29 / $116.31	Professional	26	$34.75	$43.29	$116.31
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $60.38 / $90.37 / $242.00	Professional	TC	$60.38	$90.37	$242.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $80.67 / $90.44 / $178.67	Professional		$80.67	$90.44	$178.67
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.54 / $53.68 / $74.45	Professional	26	$30.54	$53.68	$74.45
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $50.13 / $50.13 / $50.13	Professional	TC	$50.13	$50.13	$50.13
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.95 / $89.22 / $137.02	Professional		$32.95	$89.22	$137.02
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $100.47 / $151.26 / $292.25	Professional		$100.47	$151.26	$292.25
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.79 / $40.39 / $71.48	Professional	26	$37.79	$40.39	$71.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Cigna Facility/Professional Professional Modifier Low / Median / High Price $89.63 / $164.97 / $334.63	Professional		$89.63	$164.97	$334.63
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $31.17 / $47.81 / $87.90	Professional	26	$31.17	$47.81	$87.90
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.88 / $112.08 / $237.34	Professional	TC	$55.88	$112.08	$237.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $292.88 / $368.56 / $376.16	Facility	26	$292.88	$368.56	$376.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $380.99 / $1,305.85 / $1,305.85	Professional		$380.99	$1,305.85	$1,305.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $315.37 / $315.37 / $323.39	Professional	26	$315.37	$315.37	$323.39
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,108.00 / $1,108.00 / $1,108.00	Professional	TC	$1,108.00	$1,108.00	$1,108.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $53.39 / $120.42 / $298.58	Professional		$53.39	$120.42	$298.58
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.47 / $64.05 / $155.28	Professional	26	$50.47	$64.05	$155.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $109.41 / $265.24	Professional	TC	$86.20	$109.41	$265.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $42.91 / $80.97 / $176.47	Professional		$42.91	$80.97	$176.47
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $45.92 / $45.92 / $45.92	Facility	26	$45.92	$45.92	$45.92
Providence Facility/Professional Professional Modifier Low / Median / High Price $92.80 / $191.52 / $326.18	Professional		$92.80	$191.52	$326.18
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.76 / $47.71 / $86.74	Professional	26	$33.76	$47.71	$86.74
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.64 / $117.59 / $236.87	Professional	TC	$56.64	$117.59	$236.87
United Facility/Professional Professional Modifier Low / Median / High Price $99.70 / $147.58 / $256.41	Professional		$99.70	$147.58	$256.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.78 / $43.67 / $74.23	Professional	26	$34.78	$43.67	$74.23
United Facility/Professional Professional Modifier TC Low / Median / High Price $62.58 / $88.80 / $179.83	Professional	TC	$62.58	$88.80	$179.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $89.73 / $100.84 / $142.78	Professional		$89.73	$100.84	$142.78
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.13 / $38.18 / $52.69	Professional	26	$33.13	$38.18	$52.69
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $56.59 / $66.15 / $1,100.00	Professional	TC	$56.59	$66.15	$1,100.00