Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.38 / $62.99 / $80.61	Facility	26	$50.38	$62.99	$80.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $143.94 / $206.20 / $394.26	Professional		$143.94	$206.20	$394.26
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $64.70 / $168.29	Professional	26	$51.30	$64.70	$168.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $90.34 / $124.01 / $280.51	Professional	TC	$90.34	$124.01	$280.51
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.55 / $150.19 / $247.83	Professional		$120.55	$150.19	$247.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $47.91 / $60.31 / $112.29	Professional	26	$47.91	$60.31	$112.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $51.86 / $51.86 / $51.86	Professional	TC	$51.86	$51.86	$51.86
BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.98 / $128.30 / $203.03	Professional		$49.98	$128.30	$203.03
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $150.19 / $225.30 / $283.45	Professional		$150.19	$225.30	$283.45
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $57.00 / $57.00 / $61.01	Professional	26	$57.00	$57.00	$61.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.75 / $250.00 / $492.58	Professional		$134.75	$250.00	$492.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.38 / $69.34 / $125.68	Professional	26	$47.38	$69.34	$125.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $83.79 / $175.00 / $362.70	Professional	TC	$83.79	$175.00	$362.70
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $441.84 / $555.91 / $571.36	Facility	26	$441.84	$555.91	$571.36
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,417.13 / $1,670.68 / $1,670.68	Professional		$1,417.13	$1,670.68	$1,670.68
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $487.80 / $520.49 / $520.49	Professional	26	$487.80	$520.49	$520.49
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,128.24 / $1,318.41 / $1,318.41	Professional	TC	$1,128.24	$1,318.41	$1,318.41
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $150.19 / $258.32 / $626.24	Professional		$150.19	$258.32	$626.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.12 / $96.61 / $234.20	Professional	26	$76.12	$96.61	$234.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $127.41 / $161.72 / $392.04	Professional	TC	$127.41	$161.72	$392.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.54 / $123.00 / $246.68	Professional		$70.54	$123.00	$246.68
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.79 / $69.79 / $69.79	Facility	26	$69.79	$69.79	$69.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $145.36 / $265.61 / $503.69	Professional		$145.36	$265.61	$503.69
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.80 / $65.78 / $122.20	Professional	26	$50.80	$65.78	$122.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $85.54 / $167.06 / $376.39	Professional	TC	$85.54	$167.06	$376.39
United Facility/Professional Professional Modifier Low / Median / High Price $173.02 / $244.46 / $407.10	Professional		$173.02	$244.46	$407.10
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $65.31 / $112.21	Professional	26	$52.18	$65.31	$112.21
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.50 / $177.33 / $276.45	Professional	TC	$117.50	$177.33	$276.45
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $133.62 / $150.19 / $212.60	Professional		$133.62	$150.19	$212.60
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.97 / $57.58 / $79.47	Professional	26	$49.97	$57.58	$79.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.65 / $97.75 / $1,100.00	Professional	TC	$83.65	$97.75	$1,100.00