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 $138.13 / $191.06 / $451.00	Professional		$138.13	$191.06	$451.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.47 / $59.49 / $154.50	Professional	26	$47.47	$59.49	$154.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.21 / $124.81 / $301.27	Professional	TC	$91.21	$124.81	$301.27
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $110.63 / $181.84 / $236.79	Professional		$110.63	$181.84	$236.79
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.47 / $62.28 / $98.66	Professional	26	$40.47	$62.28	$98.66
BCBS Facility/Professional Professional Modifier Low / Median / High Price $44.02 / $128.01 / $197.05	Professional		$44.02	$128.01	$197.05
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $150.66 / $231.05 / $287.02	Professional		$150.66	$231.05	$287.02
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $50.08 / $50.08 / $53.78	Professional	26	$50.08	$50.08	$53.78
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $60.98 / $60.98	Facility	26	$60.98	$60.98	$60.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.30 / $237.67 / $499.31	Professional		$128.30	$237.67	$499.31
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.45 / $65.26 / $124.98	Professional	26	$40.45	$65.26	$124.98
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $84.06 / $163.16 / $372.19	Professional	TC	$84.06	$163.16	$372.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $388.00 / $488.64 / $498.88	Facility	26	$388.00	$488.64	$498.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,638.97 / $1,708.01 / $1,708.01	Professional		$1,638.97	$1,708.01	$1,708.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $384.71 / $384.71 / $428.03	Professional	26	$384.71	$384.71	$428.03
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,023.00 / $2,023.00 / $2,023.00	Professional	TC	$2,023.00	$2,023.00	$2,023.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.10 / $247.10 / $453.05	Professional		$97.10	$247.10	$453.05
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 $127.83 / $162.24 / $393.32	Professional	TC	$127.83	$162.24	$393.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $57.15 / $118.85 / $273.04	Professional		$57.15	$118.85	$273.04
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $60.98 / $60.98 / $60.98	Facility	26	$60.98	$60.98	$60.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $131.76 / $260.63 / $483.21	Professional		$131.76	$260.63	$483.21
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.17 / $63.23 / $118.75	Professional	26	$44.17	$63.23	$118.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $84.06 / $161.53 / $370.56	Professional	TC	$84.06	$161.53	$370.56
United Facility/Professional Professional Modifier Low / Median / High Price $144.18 / $220.51 / $381.65	Professional		$144.18	$220.51	$381.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.99 / $57.74 / $106.04	Professional	26	$48.99	$57.74	$106.04
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.10 / $151.15 / $272.14	Professional	TC	$95.10	$151.15	$272.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $127.82 / $143.51 / $203.39	Professional		$127.82	$143.51	$203.39
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 $83.92 / $98.07 / $1,100.00	Professional	TC	$83.92	$98.07	$1,100.00