Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $44.12 / $55.03 / $70.83	Facility	26	$44.12	$55.03	$70.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $164.32 / $227.06 / $421.79	Professional		$164.32	$227.06	$421.79
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.93 / $60.00 / $119.00	Professional	26	$46.93	$60.00	$119.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.38 / $160.80 / $339.73	Professional	TC	$117.38	$160.80	$339.73
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $136.28 / $179.44 / $215.33	Professional		$136.28	$179.44	$215.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $62.28 / $103.71	Professional	26	$40.47	$62.28	$103.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $71.09 / $71.09 / $71.09	Professional	TC	$71.09	$71.09	$71.09
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.89 / $141.56 / $220.79	Professional		$45.89	$141.56	$220.79
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $169.80 / $227.00 / $339.60	Professional		$169.80	$227.00	$339.60
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $50.08 / $54.11	Professional	26	$50.08	$50.08	$54.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $152.52 / $288.77 / $570.29	Professional		$152.52	$288.77	$570.29
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.01 / $70.50 / $132.13	Professional	26	$43.01	$70.50	$132.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.86 / $211.46 / $439.33	Professional	TC	$107.86	$211.46	$439.33
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $388.00 / $488.64 / $502.08	Facility	26	$388.00	$488.64	$502.08
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,657.47 / $1,940.92 / $1,940.92	Professional		$1,657.47	$1,940.92	$1,940.92
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $428.03 / $556.79 / $556.79	Professional	26	$428.03	$556.79	$556.79
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,335.80 / $1,561.11 / $1,561.11	Professional	TC	$1,335.80	$1,561.11	$1,561.11
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $102.36 / $266.37 / $485.55	Professional		$102.36	$266.37	$485.55
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $66.86 / $84.86 / $205.72	Professional	26	$66.86	$84.86	$205.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.00 / $208.15 / $307.60	Professional	TC	$164.00	$208.15	$307.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.98 / $158.24 / $280.07	Professional		$61.98	$158.24	$280.07
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $61.34 / $61.34 / $61.34	Facility	26	$61.34	$61.34	$61.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $165.39 / $302.86 / $578.34	Professional		$165.39	$302.86	$578.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.75 / $70.48 / $125.14	Professional	26	$44.75	$70.48	$125.14
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $110.25 / $207.16 / $445.94	Professional	TC	$110.25	$207.16	$445.94
United Facility/Professional Professional Modifier Low / Median / High Price $192.95 / $282.45 / $471.60	Professional		$192.95	$282.45	$471.60
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.75 / $66.05 / $109.41	Professional	26	$51.75	$66.05	$109.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $143.87 / $215.81 / $344.49	Professional	TC	$143.87	$215.81	$344.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.56 / $169.80 / $241.22	Professional		$151.56	$169.80	$241.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $43.89 / $50.59 / $69.84	Professional	26	$43.89	$50.59	$69.84
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $107.67 / $125.84 / $1,100.00	Professional	TC	$107.67	$125.84	$1,100.00