Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.38 / $62.99 / $80.61	Facility	26	$50.38	$62.99	$80.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $136.38 / $188.96 / $368.92	Professional		$136.38	$188.96	$368.92
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $62.99 / $137.15	Professional	26	$51.30	$62.99	$137.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $81.83 / $114.05 / $231.46	Professional	TC	$81.83	$114.05	$231.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $99.37 / $113.56 / $197.45	Professional		$99.37	$113.56	$197.45
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $46.07 / $57.58 / $112.29	Professional	26	$46.07	$57.58	$112.29
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $118.10 / $118.10 / $118.10	Professional	TC	$118.10	$118.10	$118.10
BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.98 / $126.38 / $197.40	Professional		$49.98	$126.38	$197.40
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $149.05 / $228.54 / $283.89	Professional		$149.05	$228.54	$283.89
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $57.00 / $57.00 / $61.01	Professional	26	$57.00	$57.00	$61.01
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $127.20 / $219.83 / $413.81	Professional		$127.20	$219.83	$413.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.14 / $68.95 / $125.44	Professional	26	$47.14	$68.95	$125.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $76.22 / $147.00 / $286.52	Professional	TC	$76.22	$147.00	$286.52
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $441.84 / $555.91 / $568.24	Facility	26	$441.84	$555.91	$568.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,403.43 / $1,417.13 / $1,417.13	Professional		$1,403.43	$1,417.13	$1,417.13
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $384.88 / $384.88 / $487.80	Professional	26	$384.88	$384.88	$487.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,332.00 / $1,332.00 / $1,332.00	Professional	TC	$1,332.00	$1,332.00	$1,332.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $106.77 / $243.90 / $467.25	Professional		$106.77	$243.90	$467.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $76.12 / $96.61 / $234.20	Professional	26	$76.12	$96.61	$234.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.06 / $147.31 / $357.12	Professional	TC	$116.06	$147.31	$357.12
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.97 / $112.57 / $261.87	Professional		$59.97	$112.57	$261.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.44 / $69.44 / $69.44	Facility	26	$69.44	$69.44	$69.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $132.60 / $238.26 / $424.31	Professional		$132.60	$238.26	$424.31
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.97 / $65.78 / $122.82	Professional	26	$50.97	$65.78	$122.82
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $76.34 / $147.00 / $284.08	Professional	TC	$76.34	$147.00	$284.08
United Facility/Professional Professional Modifier Low / Median / High Price $142.03 / $203.12 / $357.09	Professional		$142.03	$203.12	$357.09
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.50 / $65.68 / $122.32	Professional	26	$52.50	$65.68	$122.32
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $131.83 / $236.46	Professional	TC	$86.20	$131.83	$236.46
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $126.16 / $141.94 / $200.79	Professional		$126.16	$141.94	$200.79
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.97 / $57.58 / $79.47	Professional	26	$49.97	$57.58	$79.47
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $76.20 / $89.07 / $1,100.00	Professional	TC	$76.20	$89.07	$1,100.00