Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.29 / $91.58 / $110.00	Facility	26	$58.29	$91.58	$110.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $237.95 / $370.50 / $638.00	Professional		$237.95	$370.50	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $99.12 / $180.70	Professional	26	$62.50	$99.12	$180.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $171.57 / $259.35 / $433.05	Professional	TC	$171.57	$259.35	$433.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.71 / $113.62 / $137.63	Professional	26	$53.71	$113.62	$137.63
BCBS Facility/Professional Professional Modifier Low / Median / High Price $59.32 / $179.26 / $300.17	Professional		$59.32	$179.26	$300.17
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $244.07 / $347.84 / $439.33	Professional		$244.07	$347.84	$439.33
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $66.45 / $66.45 / $71.56	Professional	26	$66.45	$66.45	$71.56
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $81.40 / $81.40	Facility	26	$81.40	$81.40	$81.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $208.40 / $435.00 / $865.11	Professional		$208.40	$435.00	$865.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.36 / $75.25 / $147.25	Professional	26	$50.36	$75.25	$147.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $149.06 / $325.93 / $724.30	Professional	TC	$149.06	$325.93	$724.30
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $515.04 / $648.08 / $666.24	Facility	26	$515.04	$648.08	$666.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,882.90 / $3,076.60 / $3,076.60	Professional		$2,882.90	$3,076.60	$3,076.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $596.05 / $867.00 / $867.00	Professional	26	$596.05	$867.00	$867.00
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,573.94 / $2,747.24 / $2,790.07	Professional	TC	$2,573.94	$2,747.24	$2,790.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $309.32 / $419.72 / $587.04	Professional		$309.32	$419.72	$587.04
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $88.73 / $112.61 / $273.00	Professional	26	$88.73	$112.61	$273.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $226.66 / $287.68 / $697.40	Professional	TC	$226.66	$287.68	$697.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.09 / $245.92 / $476.23	Professional		$77.09	$245.92	$476.23
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $81.40 / $81.40 / $81.40	Facility	26	$81.40	$81.40	$81.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $225.99 / $462.75 / $826.90	Professional		$225.99	$462.75	$826.90
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.36 / $75.29 / $145.99	Professional	26	$50.36	$75.29	$145.99
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $152.19 / $314.75 / $724.30	Professional	TC	$152.19	$314.75	$724.30
United Facility/Professional Professional Modifier Low / Median / High Price $245.07 / $398.83 / $709.18	Professional		$245.07	$398.83	$709.18
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.97 / $76.87 / $130.68	Professional	26	$48.97	$76.87	$130.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.94 / $318.70 / $564.53	Professional	TC	$176.94	$318.70	$564.53
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $207.05 / $231.89 / $329.49	Professional		$207.05	$231.89	$329.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.25 / $67.14 / $92.65	Professional	26	$58.25	$67.14	$92.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $148.80 / $173.91 / $1,400.00	Professional	TC	$148.80	$173.91	$1,400.00