Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.81 / $62.29 / $79.31	Facility	26	$49.81	$62.29	$79.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $186.45 / $256.85 / $463.18	Professional		$186.45	$256.85	$463.18
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $62.29 / $105.37	Professional	26	$51.30	$62.29	$105.37
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $136.65 / $184.55 / $352.11	Professional	TC	$136.65	$184.55	$352.11
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.29 / $208.82 / $283.23	Professional		$138.29	$208.82	$283.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.15 / $104.19 / $116.13	Professional	26	$48.15	$104.19	$116.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $98.64 / $98.64 / $98.64	Professional	TC	$98.64	$98.64	$98.64
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.81 / $161.93 / $262.57	Professional		$53.81	$161.93	$262.57
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $197.56 / $246.95 / $317.00	Professional		$197.56	$246.95	$317.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.07 / $59.52 / $152.94	Professional	26	$56.07	$59.52	$152.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $177.49 / $325.00 / $650.14	Professional		$177.49	$325.00	$650.14
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.15 / $76.50 / $138.62	Professional	26	$48.15	$76.50	$138.62
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.35 / $247.22 / $504.45	Professional	TC	$127.35	$247.22	$504.45
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $434.48 / $546.72 / $561.91	Facility	26	$434.48	$546.72	$561.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,999.32 / $2,220.23 / $2,220.23	Professional		$1,999.32	$2,220.23	$2,220.23
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $479.55 / $590.91 / $590.91	Professional	26	$479.55	$590.91	$590.91
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,624.23 / $1,822.59 / $1,825.48	Professional	TC	$1,624.23	$1,822.59	$1,825.48
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $258.36 / $341.04 / $634.50	Professional		$258.36	$341.04	$634.50
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.84 / $95.01 / $230.32	Professional	26	$74.84	$95.01	$230.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $193.86 / $246.05 / $596.48	Professional	TC	$193.86	$246.05	$596.48
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.44 / $187.35 / $326.72	Professional		$69.44	$187.35	$326.72
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $191.92 / $350.00 / $656.64	Professional		$191.92	$350.00	$656.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.14 / $76.50 / $130.85	Professional	26	$50.14	$76.50	$130.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $130.80 / $231.59 / $507.79	Professional	TC	$130.80	$231.59	$507.79
United Facility/Professional Professional Modifier Low / Median / High Price $213.81 / $314.50 / $537.54	Professional		$213.81	$314.50	$537.54
United Facility/Professional Professional Modifier 26 Low / Median / High Price $55.32 / $70.45 / $120.58	Professional	26	$55.32	$70.45	$120.58
United Facility/Professional Professional Modifier TC Low / Median / High Price $158.90 / $232.59 / $411.83	Professional	TC	$158.90	$232.59	$411.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $176.40 / $197.56 / $280.76	Professional		$176.40	$197.56	$280.76
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.14 / $56.65 / $78.15	Professional	26	$49.14	$56.65	$78.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $127.27 / $148.76 / $1,100.00	Professional	TC	$127.27	$148.76	$1,100.00