Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.09 / $61.17 / $79.73	Facility	26	$50.09	$61.17	$79.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $156.38 / $212.72 / $449.34	Professional		$156.38	$212.72	$449.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.97 / $63.23 / $156.61	Professional	26	$50.97	$63.23	$156.61
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.69 / $139.69 / $295.58	Professional	TC	$103.69	$139.69	$295.58
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $130.90 / $138.24 / $291.08	Professional		$130.90	$138.24	$291.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.56 / $59.67 / $111.06	Professional	26	$45.56	$59.67	$111.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $119.28 / $119.28 / $149.34	Professional	TC	$119.28	$119.28	$149.34
BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.43 / $139.31 / $218.25	Professional		$49.43	$139.31	$218.25
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $179.99 / $257.72 / $327.26	Professional		$179.99	$257.72	$327.26
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.38 / $59.86 / $139.24	Professional	26	$56.38	$59.86	$139.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $146.88 / $255.00 / $494.31	Professional		$146.88	$255.00	$494.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.87 / $71.59 / $124.96	Professional	26	$46.87	$71.59	$124.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.47 / $178.50 / $362.84	Professional	TC	$96.47	$178.50	$362.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $436.88 / $549.76 / $565.04	Facility	26	$436.88	$549.76	$565.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,897.57 / $1,954.49 / $1,954.49	Professional		$1,897.57	$1,954.49	$1,954.49
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $435.88 / $435.88 / $482.33	Professional	26	$435.88	$435.88	$482.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,600.00 / $1,624.23 / $1,624.23	Professional	TC	$1,600.00	$1,624.23	$1,624.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $106.08 / $256.19 / $520.00	Professional		$106.08	$256.19	$520.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.27 / $95.54 / $231.60	Professional	26	$75.27	$95.54	$231.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.76 / $186.27 / $451.56	Professional	TC	$146.76	$186.27	$451.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.27 / $136.38 / $286.08	Professional		$64.27	$136.38	$286.08
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $151.96 / $275.00 / $500.78	Professional		$151.96	$275.00	$500.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $71.23 / $123.00	Professional	26	$50.42	$71.23	$123.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $96.51 / $178.50 / $356.34	Professional	TC	$96.51	$178.50	$356.34
United Facility/Professional Professional Modifier Low / Median / High Price $160.47 / $231.55 / $410.52	Professional		$160.47	$231.55	$410.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.86 / $64.95 / $111.57	Professional	26	$51.86	$64.95	$111.57
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.82 / $156.57 / $282.83	Professional	TC	$109.82	$156.57	$282.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $145.76 / $163.63 / $231.94	Professional		$145.76	$163.63	$231.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.42 / $56.95 / $78.59	Professional	26	$49.42	$56.95	$78.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $96.35 / $112.60 / $1,100.00	Professional	TC	$96.35	$112.60	$1,100.00