Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.03 / $51.27 / $74.59	Facility	26	$22.03	$51.27	$74.59
Aetna Facility/Professional Professional Modifier Low / Median / High Price $118.97 / $171.00 / $371.00	Professional		$118.97	$171.00	$371.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.42 / $54.85 / $171.84	Professional	26	$42.42	$54.85	$171.84
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $60.17 / $78.31 / $140.38	Professional	52	$60.17	$78.31	$140.38
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.20 / $114.53 / $291.63	Professional	TC	$75.20	$114.53	$291.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $92.80 / $110.61 / $223.03	Professional		$92.80	$110.61	$223.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.69 / $64.11 / $94.31	Professional	26	$38.69	$64.11	$94.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $54.13 / $65.77 / $197.37	Professional	TC	$54.13	$65.77	$197.37
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.01 / $107.70 / $165.80	Professional		$42.01	$107.70	$165.80
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $125.22 / $178.97 / $296.57	Professional		$125.22	$178.97	$296.57
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $47.88 / $50.63 / $71.95	Professional	26	$47.88	$50.63	$71.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.68 / $210.00 / $417.93	Professional		$112.68	$210.00	$417.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $62.12 / $111.29	Professional	26	$39.81	$62.12	$111.29
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.88 / $147.00 / $307.20	Professional	TC	$69.88	$147.00	$307.20
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $371.04 / $466.96 / $479.84	Facility	26	$371.04	$466.96	$479.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,609.32 / $1,657.60 / $1,657.60	Professional		$1,609.32	$1,657.60	$1,657.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $394.61 / $394.61 / $409.43	Professional	26	$394.61	$394.61	$409.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,384.00 / $1,384.00 / $1,384.00	Professional	TC	$1,384.00	$1,384.00	$1,384.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $73.31 / $187.07 / $515.86	Professional		$73.31	$187.07	$515.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.92 / $81.13 / $196.68	Professional	26	$63.92	$81.13	$196.68
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $106.39 / $135.04 / $327.36	Professional	TC	$106.39	$135.04	$327.36
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.25 / $102.83 / $227.34	Professional		$54.25	$102.83	$227.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $58.64 / $58.64 / $58.64	Facility	26	$58.64	$58.64	$58.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.00 / $226.37 / $413.75	Professional		$123.00	$226.37	$413.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.24 / $61.33 / $106.68	Professional	26	$41.24	$61.33	$106.68
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.37 / $147.00 / $307.20	Professional	TC	$71.37	$147.00	$307.20
United Facility/Professional Professional Modifier Low / Median / High Price $136.51 / $200.50 / $351.56	Professional		$136.51	$200.50	$351.56
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.40 / $59.19 / $101.35	Professional	26	$45.40	$59.19	$101.35
United Facility/Professional Professional Modifier TC Low / Median / High Price $86.20 / $131.83 / $241.59	Professional	TC	$86.20	$131.83	$241.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.80 / $125.70 / $177.94	Professional		$111.80	$125.70	$177.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $41.97 / $48.37 / $66.73	Professional	26	$41.97	$48.37	$66.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.84 / $81.64 / $1,100.00	Professional	TC	$69.84	$81.64	$1,100.00