Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.53 / $85.62 / $125.55	Facility	26	$68.53	$85.62	$125.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $217.83 / $309.66 / $615.49	Professional		$217.83	$309.66	$615.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.53 / $88.35 / $243.01	Professional	26	$68.53	$88.35	$243.01
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.29 / $213.56 / $449.84	Professional	TC	$149.29	$213.56	$449.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $182.45 / $246.70 / $407.06	Professional		$182.45	$246.70	$407.06
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.62 / $86.11 / $152.65	Professional	26	$62.62	$86.11	$152.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $108.64 / $108.64 / $108.64	Professional	TC	$108.64	$108.64	$108.64
BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.09 / $192.40 / $302.66	Professional		$68.09	$192.40	$302.66
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $246.70 / $371.57 / $520.90	Professional		$246.70	$371.57	$520.90
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $77.48 / $77.48 / $83.56	Professional	26	$77.48	$77.48	$83.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Cigna Facility/Professional Professional Modifier Low / Median / High Price $233.00 / $410.00 / $865.90	Professional		$233.00	$410.00	$865.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.18 / $93.67 / $170.31	Professional	26	$64.18	$93.67	$170.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $162.72 / $293.97 / $679.60	Professional	TC	$162.72	$293.97	$679.60
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $600.40 / $755.84 / $773.84	Facility	26	$600.40	$755.84	$773.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $850.00 / $3,234.12 / $3,234.12	Professional		$850.00	$3,234.12	$3,234.12
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $559.72 / $559.72 / $662.48	Professional	26	$559.72	$559.72	$662.48
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,441.41 / $2,749.60 / $2,752.56	Professional	TC	$2,441.41	$2,749.60	$2,752.56
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $116.53 / $340.45 / $679.63	Professional		$116.53	$340.45	$679.63
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.44 / $131.29 / $318.27	Professional	26	$103.44	$131.29	$318.27
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $250.63 / $318.10 / $771.16	Professional	TC	$250.63	$318.10	$771.16
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $88.32 / $231.30 / $481.67	Professional		$88.32	$231.30	$481.67
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.56 / $94.56 / $94.56	Facility	26	$94.56	$94.56	$94.56
Providence Facility/Professional Professional Modifier Low / Median / High Price $241.66 / $439.76 / $855.86	Professional		$241.66	$439.76	$855.86
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $69.26 / $88.10 / $167.38	Professional	26	$69.26	$88.10	$167.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $164.69 / $280.57 / $726.47	Professional	TC	$164.69	$280.57	$726.47
United Facility/Professional Professional Modifier Low / Median / High Price $245.87 / $384.22 / $653.57	Professional		$245.87	$384.22	$653.57
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.36 / $89.50 / $152.15	Professional	26	$71.36	$89.50	$152.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $169.48 / $275.41 / $521.59	Professional	TC	$169.48	$275.41	$521.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $220.02 / $246.70 / $350.15	Professional		$220.02	$246.70	$350.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.91 / $78.28 / $108.03	Professional	26	$67.91	$78.28	$108.03
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $152.11 / $177.78 / $1,100.00	Professional	TC	$152.11	$177.78	$1,100.00