Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.34 / $67.01 / $86.42	Facility	26	$54.34	$67.01	$86.42
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.21 / $240.34 / $593.16	Professional		$168.21	$240.34	$593.16
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.00 / $72.56 / $207.00	Professional	26	$55.00	$72.56	$207.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.15 / $151.19 / $316.44	Professional	TC	$109.15	$151.19	$316.44
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $138.88 / $159.02 / $308.68	Professional		$138.88	$159.02	$308.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $67.90 / $120.38	Professional	26	$50.42	$67.90	$120.38
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $125.09 / $156.62 / $238.26	Professional	TC	$125.09	$156.62	$238.26
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.82 / $148.08 / $234.81	Professional		$53.82	$148.08	$234.81
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $173.60 / $259.00 / $347.20	Professional		$173.60	$259.00	$347.20
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $61.11 / $64.91 / $125.46	Professional	26	$61.11	$64.91	$125.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Cigna Facility/Professional Professional Modifier Low / Median / High Price $155.74 / $264.76 / $496.73	Professional		$155.74	$264.76	$496.73
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.80 / $75.00 / $134.38	Professional	26	$50.80	$75.00	$134.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $101.16 / $182.69 / $360.58	Professional	TC	$101.16	$182.69	$360.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $473.36 / $596.24 / $612.88	Facility	26	$473.36	$596.24	$612.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,657.47 / $1,680.90 / $1,680.90	Professional		$1,657.47	$1,680.90	$1,680.90
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $414.94 / $414.94 / $522.08	Professional	26	$414.94	$414.94	$522.08
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,425.00 / $1,425.00 / $1,425.00	Professional	TC	$1,425.00	$1,425.00	$1,425.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $109.39 / $267.61 / $552.08	Professional		$109.39	$267.61	$552.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $81.58 / $103.54 / $251.00	Professional	26	$81.58	$103.54	$251.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $153.91 / $195.34 / $473.56	Professional	TC	$153.91	$195.34	$473.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.43 / $142.96 / $320.64	Professional		$69.43	$142.96	$320.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $74.84 / $74.84 / $74.84	Facility	26	$74.84	$74.84	$74.84
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.77 / $288.67 / $516.64	Professional		$162.77	$288.67	$516.64
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.59 / $70.64 / $130.01	Professional	26	$54.59	$70.64	$130.01
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $101.22 / $182.00 / $359.85	Professional	TC	$101.22	$182.00	$359.85
United Facility/Professional Professional Modifier Low / Median / High Price $174.85 / $246.85 / $411.42	Professional		$174.85	$246.85	$411.42
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.37 / $70.73 / $123.80	Professional	26	$56.37	$70.73	$123.80
United Facility/Professional Professional Modifier TC Low / Median / High Price $114.72 / $172.09 / $294.13	Professional	TC	$114.72	$172.09	$294.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $154.60 / $173.60 / $246.04	Professional		$154.60	$173.60	$246.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.56 / $61.73 / $85.21	Professional	26	$53.56	$61.73	$85.21
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $101.04 / $118.09 / $1,100.00	Professional	TC	$101.04	$118.09	$1,100.00