Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.54 / $56.78 / $73.75	Facility	26	$45.54	$56.78	$73.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $145.96 / $210.14 / $604.52	Professional		$145.96	$210.14	$604.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $59.82 / $210.87	Professional	26	$48.98	$59.82	$210.87
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $100.50 / $141.81 / $298.43	Professional	TC	$100.50	$141.81	$298.43
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $72.19 / $132.91 / $215.56	Professional		$72.19	$132.91	$215.56
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.96 / $54.66 / $101.74	Professional	26	$40.96	$54.66	$101.74
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $44.75 / $73.59 / $117.57	Professional	TC	$44.75	$73.59	$117.57
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.31 / $138.93 / $208.13	Professional		$45.31	$138.93	$208.13
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $157.06 / $246.00 / $481.56	Professional		$157.06	$246.00	$481.56
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.65 / $55.13 / $62.31	Professional	26	$51.65	$55.13	$62.31
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Cigna Facility/Professional Professional Modifier Low / Median / High Price $141.22 / $252.33 / $499.01	Professional		$141.22	$252.33	$499.01
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.17 / $69.09 / $121.06	Professional	26	$44.17	$69.09	$121.06
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.09 / $179.92 / $381.38	Professional	TC	$95.09	$179.92	$381.38
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $400.16 / $504.00 / $518.00	Facility	26	$400.16	$504.00	$518.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $578.58 / $1,947.01 / $1,947.01	Professional		$578.58	$1,947.01	$1,947.01
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $450.76 / $450.76 / $450.76	Professional	26	$450.76	$450.76	$450.76
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,576.92 / $1,624.23 / $1,624.23	Professional	TC	$1,576.92	$1,624.23	$1,624.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $78.33 / $213.62 / $567.75	Professional		$78.33	$213.62	$567.75
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.97 / $87.53 / $212.20	Professional	26	$68.97	$87.53	$212.20
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $144.65 / $183.60 / $445.08	Professional	TC	$144.65	$183.60	$445.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.01 / $138.97 / $282.32	Professional		$60.01	$138.97	$282.32
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $63.24 / $63.24 / $63.24	Facility	26	$63.24	$63.24	$63.24
Providence Facility/Professional Professional Modifier Low / Median / High Price $151.72 / $277.89 / $501.36	Professional		$151.72	$277.89	$501.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.14 / $68.75 / $117.37	Professional	26	$46.14	$68.75	$117.37
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $97.20 / $175.58 / $381.01	Professional	TC	$97.20	$175.58	$381.01
United Facility/Professional Professional Modifier Low / Median / High Price $169.33 / $241.80 / $434.94	Professional		$169.33	$241.80	$434.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.25 / $63.88 / $113.20	Professional	26	$50.25	$63.88	$113.20
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.03 / $173.89 / $301.77	Professional	TC	$115.03	$173.89	$301.77
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $140.24 / $157.32 / $223.20	Professional		$140.24	$157.32	$223.20
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.28 / $52.18 / $72.04	Professional	26	$45.28	$52.18	$72.04
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $94.97 / $110.99 / $1,100.00	Professional	TC	$94.97	$110.99	$1,100.00