Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.43 / $77.48 / $101.15	Facility	26	$63.43	$77.48	$101.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.96 / $275.00 / $543.33	Professional		$194.96	$275.00	$543.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.17 / $78.56 / $152.56	Professional	26	$62.17	$78.56	$152.56
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.53 / $178.14 / $362.14	Professional	TC	$131.53	$178.14	$362.14
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $145.78 / $175.82 / $289.69	Professional		$145.78	$175.82	$289.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.80 / $79.48 / $148.11	Professional	26	$57.80	$79.48	$148.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $190.43 / $190.43 / $190.43	Professional	TC	$190.43	$190.43	$190.43
BCBS Facility/Professional Professional Modifier Low / Median / High Price $62.61 / $179.94 / $269.95	Professional		$62.61	$179.94	$269.95
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $208.26 / $296.70 / $416.52	Professional		$208.26	$296.70	$416.52
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $71.51 / $71.51 / $77.69	Professional	26	$71.51	$71.51	$77.69
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.81 / $314.66 / $591.90	Professional		$186.81	$314.66	$591.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.07 / $81.19 / $153.10	Professional	26	$58.07	$81.19	$153.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.94 / $222.94 / $447.34	Professional	TC	$122.94	$222.94	$447.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $553.91 / $697.76 / $714.16	Facility	26	$553.91	$697.76	$714.16
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,997.15 / $2,036.01 / $2,036.01	Professional		$1,997.15	$2,036.01	$2,036.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $484.69 / $484.69 / $610.73	Professional	26	$484.69	$484.69	$610.73
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,005.00 / $2,005.00 / $2,005.00	Professional	TC	$2,005.00	$2,005.00	$2,005.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $215.52 / $358.66 / $869.48	Professional		$215.52	$358.66	$869.48
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $95.46 / $121.16 / $293.72	Professional	26	$95.46	$121.16	$293.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $187.12 / $237.50 / $575.76	Professional	TC	$187.12	$237.50	$575.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $81.19 / $173.11 / $382.76	Professional		$81.19	$173.11	$382.76
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $87.25 / $87.25 / $87.25	Facility	26	$87.25	$87.25	$87.25
Providence Facility/Professional Professional Modifier Low / Median / High Price $193.56 / $336.64 / $621.76	Professional		$193.56	$336.64	$621.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $59.51 / $79.41 / $144.49	Professional	26	$59.51	$79.41	$144.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.07 / $220.29 / $441.62	Professional	TC	$123.07	$220.29	$441.62
United Facility/Professional Professional Modifier Low / Median / High Price $211.36 / $294.45 / $497.32	Professional		$211.36	$294.45	$497.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.94 / $82.89 / $141.72	Professional	26	$58.94	$82.89	$141.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.50 / $210.74 / $368.40	Professional	TC	$140.50	$210.74	$368.40
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $185.52 / $208.26 / $295.27	Professional		$185.52	$208.26	$295.27
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $62.67 / $72.25 / $99.71	Professional	26	$62.67	$72.25	$99.71
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $122.85 / $143.59 / $1,100.00	Professional	TC	$122.85	$143.59	$1,100.00