Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.47 / $40.86 / $56.81	Facility	26	$33.47	$40.86	$56.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.76 / $176.28 / $580.65	Professional		$115.76	$176.28	$580.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.61 / $51.30 / $160.62	Professional	26	$35.61	$51.30	$160.62
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $57.89 / $73.67 / $143.13	Professional	52	$57.89	$73.67	$143.13
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.25 / $114.39 / $251.00	Professional	TC	$79.25	$114.39	$251.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.32 / $113.50 / $152.99	Professional		$93.32	$113.50	$152.99
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.61 / $54.11 / $75.04	Professional	26	$30.61	$54.11	$75.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.22 / $101.63 / $153.02	Professional		$33.22	$101.63	$153.02
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $120.58 / $181.07 / $320.00	Professional		$120.58	$181.07	$320.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $38.10 / $40.72 / $101.28	Professional	26	$38.10	$40.72	$101.28
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Cigna Facility/Professional Professional Modifier Low / Median / High Price $108.37 / $210.00 / $413.75	Professional		$108.37	$210.00	$413.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.69 / $55.70 / $103.10	Professional	26	$32.69	$55.70	$103.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.81 / $147.00 / $297.20	Professional	TC	$73.81	$147.00	$297.20
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $295.27 / $371.60 / $379.28	Facility	26	$295.27	$371.60	$379.28
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $731.00 / $1,413.47 / $1,413.47	Professional		$731.00	$1,413.47	$1,413.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $333.52 / $333.52 / $333.52	Professional	26	$333.52	$333.52	$333.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,220.00 / $1,220.00 / $1,220.00	Professional	TC	$1,220.00	$1,220.00	$1,220.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $69.45 / $164.00 / $418.21	Professional		$69.45	$164.00	$418.21
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.88 / $64.58 / $156.56	Professional	26	$50.88	$64.58	$156.56
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $101.43 / $160.16 / $409.60	Professional	52	$101.43	$160.16	$409.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $113.11 / $143.57 / $348.04	Professional	TC	$113.11	$143.57	$348.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $43.60 / $105.62 / $228.34	Professional		$43.60	$105.62	$228.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $46.27 / $46.27 / $46.27	Facility	26	$46.27	$46.27	$46.27
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.17 / $216.27 / $406.81	Professional		$112.17	$216.27	$406.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $34.07 / $55.43 / $100.64	Professional	26	$34.07	$55.43	$100.64
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $74.29 / $147.00 / $293.02	Professional	TC	$74.29	$147.00	$293.02
United Facility/Professional Professional Modifier Low / Median / High Price $120.25 / $188.89 / $326.12	Professional		$120.25	$188.89	$326.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.18 / $46.06 / $83.66	Professional	26	$37.18	$46.06	$83.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.82 / $128.29 / $226.41	Professional	TC	$82.82	$128.29	$226.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $107.67 / $120.71 / $171.36	Professional		$107.67	$120.71	$171.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $33.40 / $38.47 / $53.14	Professional	26	$33.40	$38.47	$53.14
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $74.26 / $86.81 / $1,100.00	Professional	TC	$74.26	$86.81	$1,100.00