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 / $133.91	Facility	26	$68.53	$85.62	$133.91
Aetna Facility/Professional Professional Modifier Low / Median / High Price $217.83 / $306.02 / $615.49	Professional		$217.83	$306.02	$615.49
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.53 / $87.84 / $255.02	Professional	26	$68.53	$87.84	$255.02
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.29 / $213.72 / $422.17	Professional	TC	$149.29	$213.72	$422.17
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $104.40 / $208.12 / $343.16	Professional		$104.40	$208.12	$343.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.62 / $82.03 / $152.65	Professional	26	$62.62	$82.03	$152.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $108.46 / $145.49 / $145.49	Professional	TC	$108.46	$145.49	$145.49
BCBS Facility/Professional Professional Modifier Low / Median / High Price $68.09 / $195.62 / $309.27	Professional		$68.09	$195.62	$309.27
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $246.70 / $383.00 / $520.29	Professional		$246.70	$383.00	$520.29
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 $229.89 / $425.44 / $889.86	Professional		$229.89	$425.44	$889.86
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.72 / $95.42 / $172.13	Professional	26	$62.72	$95.42	$172.13
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.22 / $312.68 / $738.66	Professional	TC	$161.22	$312.68	$738.66
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 $860.32 / $3,248.56 / $3,248.56	Professional		$860.32	$3,248.56	$3,248.56
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $662.48 / $880.00 / $880.00	Professional	26	$662.48	$880.00	$880.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,441.41 / $2,762.21 / $2,765.07	Professional	TC	$2,441.41	$2,762.21	$2,765.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $112.00 / $346.84 / $769.84	Professional		$112.00	$346.84	$769.84
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 $250.20 / $317.56 / $769.84	Professional	TC	$250.20	$317.56	$769.84
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $88.02 / $227.34 / $476.54	Professional		$88.02	$227.34	$476.54
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 $238.34 / $488.98 / $872.60	Professional		$238.34	$488.98	$872.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.48 / $89.58 / $168.50	Professional	26	$68.48	$89.58	$168.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $164.42 / $304.94 / $746.41	Professional	TC	$164.42	$304.94	$746.41
United Facility/Professional Professional Modifier Low / Median / High Price $251.08 / $391.29 / $677.23	Professional		$251.08	$391.29	$677.23
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.59 / $89.50 / $158.59	Professional	26	$71.59	$89.50	$158.59
United Facility/Professional Professional Modifier TC Low / Median / High Price $179.76 / $278.44 / $551.98	Professional	TC	$179.76	$278.44	$551.98
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