Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.08 / $108.96 / $130.35	Facility	26	$69.08	$108.96	$130.35
Aetna Facility/Professional Professional Modifier Low / Median / High Price $257.92 / $420.75 / $661.50	Professional		$257.92	$420.75	$661.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $69.08 / $118.27 / $196.00	Professional	26	$69.08	$118.27	$196.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $125.00 / $185.53 / $301.50	Professional	52	$125.00	$185.53	$301.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $183.25 / $282.87 / $462.42	Professional	TC	$183.25	$282.87	$462.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $178.50 / $210.38 / $266.83	Professional		$178.50	$210.38	$266.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.77 / $112.21 / $163.71	Professional	26	$67.77	$112.21	$163.71
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $180.59 / $180.59 / $180.59	Professional	TC	$180.59	$180.59	$180.59
BCBS Facility/Professional Professional Modifier Low / Median / High Price $69.47 / $208.68 / $329.69	Professional		$69.47	$208.68	$329.69
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $268.17 / $408.00 / $510.00	Professional		$268.17	$408.00	$510.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $76.68 / $79.06 / $83.70	Professional	26	$76.68	$79.06	$83.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Cigna Facility/Professional Professional Modifier Low / Median / High Price $229.00 / $435.00 / $896.06	Professional		$229.00	$435.00	$896.06
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.73 / $102.38 / $181.20	Professional	26	$66.73	$102.38	$181.20
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.35 / $307.39 / $722.38	Professional	TC	$158.35	$307.39	$722.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $612.55 / $771.20 / $789.76	Facility	26	$612.55	$771.20	$789.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,445.62 / $3,548.99 / $3,548.99	Professional		$3,445.62	$3,548.99	$3,548.99
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $672.00 / $672.00 / $675.90	Professional	26	$672.00	$672.00	$675.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,996.90 / $3,086.80 / $3,086.80	Professional	TC	$2,996.90	$3,086.80	$3,086.80
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $312.64 / $439.79 / $1,066.16	Professional		$312.64	$439.79	$1,066.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $105.55 / $133.96 / $324.76	Professional	26	$105.55	$133.96	$324.76
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $240.96 / $305.83 / $741.40	Professional	TC	$240.96	$305.83	$741.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $89.81 / $223.39 / $482.44	Professional		$89.81	$223.39	$482.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $96.46 / $96.46 / $96.46	Facility	26	$96.46	$96.46	$96.46
Providence Facility/Professional Professional Modifier Low / Median / High Price $239.01 / $475.00 / $871.32	Professional		$239.01	$475.00	$871.32
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.65 / $102.38 / $174.00	Professional	26	$70.65	$102.38	$174.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $162.19 / $307.39 / $722.93	Professional	TC	$162.19	$307.39	$722.93
United Facility/Professional Professional Modifier Low / Median / High Price $266.58 / $407.71 / $794.08	Professional		$266.58	$407.71	$794.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $72.80 / $91.31 / $173.02	Professional	26	$72.80	$91.31	$173.02
United Facility/Professional Professional Modifier TC Low / Median / High Price $188.96 / $266.77 / $567.34	Professional	TC	$188.96	$266.77	$567.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $227.48 / $255.00 / $362.03	Professional		$227.48	$255.00	$362.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $69.29 / $79.86 / $110.23	Professional	26	$69.29	$79.86	$110.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $158.19 / $184.88 / $1,400.00	Professional	TC	$158.19	$184.88	$1,400.00