Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.81 / $60.84 / $79.31	Facility	26	$49.81	$60.84	$79.31
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.65 / $225.20 / $506.67	Professional		$168.65	$225.20	$506.67
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $63.85 / $93.87	Professional	26	$51.30	$63.85	$93.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $115.64 / $152.90 / $375.94	Professional	TC	$115.64	$152.90	$375.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.39 / $147.40 / $241.21	Professional		$121.39	$147.40	$241.21
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.32 / $56.65 / $110.46	Professional	26	$45.32	$56.65	$110.46
BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.40 / $143.00 / $236.16	Professional		$59.40	$143.00	$236.16
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $173.41 / $199.42 / $328.03	Professional		$173.41	$199.42	$328.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.07 / $59.86 / $137.10	Professional	26	$56.07	$59.86	$137.10
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 $155.71 / $286.45 / $601.61	Professional		$155.71	$286.45	$601.61
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.63 / $76.50 / $133.85	Professional	26	$46.63	$76.50	$133.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $105.57 / $204.23 / $440.81	Professional	TC	$105.57	$204.23	$440.81
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 $1,989.67 / $2,075.08 / $2,075.08	Professional		$1,989.67	$2,075.08	$2,075.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $460.66 / $460.66 / $479.55	Professional	26	$460.66	$460.66	$479.55
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,624.23 / $1,685.33 / $1,726.78	Professional	TC	$1,624.23	$1,685.33	$1,726.78
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $226.43 / $298.88 / $641.25	Professional		$226.43	$298.88	$641.25
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 $160.63 / $203.87 / $494.24	Professional	TC	$160.63	$203.87	$494.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.11 / $149.94 / $331.37	Professional		$64.11	$149.94	$331.37
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 $161.36 / $314.91 / $575.55	Professional		$161.36	$314.91	$575.55
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.14 / $76.06 / $128.31	Professional	26	$50.14	$76.06	$128.31
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $105.64 / $192.50 / $437.96	Professional	TC	$105.64	$192.50	$437.96
United Facility/Professional Professional Modifier Low / Median / High Price $175.77 / $267.31 / $465.28	Professional		$175.77	$267.31	$465.28
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.79 / $65.06 / $116.02	Professional	26	$53.79	$65.06	$116.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $113.46 / $184.38 / $304.57	Professional	TC	$113.46	$184.38	$304.57
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $154.60 / $173.41 / $246.02	Professional		$154.60	$173.41	$246.02
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 $105.45 / $123.25 / $1,100.00	Professional	TC	$105.45	$123.25	$1,100.00