Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.24 / $61.59 / $78.40	Facility	26	$49.24	$61.59	$78.40
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.39 / $246.26 / $436.33	Professional		$173.39	$246.26	$436.33
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $62.95 / $136.12	Professional	26	$51.30	$62.95	$136.12
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.15 / $168.52 / $353.66	Professional	TC	$124.15	$168.52	$353.66
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $64.64 / $156.15 / $193.92	Professional		$64.64	$156.15	$193.92
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.80 / $56.00 / $109.20	Professional	26	$44.80	$56.00	$109.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.95 / $102.95 / $109.48	Professional	TC	$102.95	$102.95	$109.48
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.33 / $150.72 / $232.41	Professional		$48.33	$150.72	$232.41
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $184.68 / $269.00 / $369.36	Professional		$184.68	$269.00	$369.36
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $55.44 / $58.85 / $184.36	Professional	26	$55.44	$58.85	$184.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.91 / $300.93 / $602.46	Professional		$165.91	$300.93	$602.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.60 / $75.90 / $133.66	Professional	26	$47.60	$75.90	$133.66
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.32 / $220.14 / $477.68	Professional	TC	$116.32	$220.14	$477.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $429.60 / $540.48 / $553.04	Facility	26	$429.60	$540.48	$553.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,319.03 / $2,388.60 / $2,388.60	Professional		$2,319.03	$2,388.60	$2,388.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $543.21 / $543.21 / $543.21	Professional	26	$543.21	$543.21	$543.21
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,973.17 / $2,032.36 / $2,032.36	Professional	TC	$1,973.17	$2,032.36	$2,032.36
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $112.10 / $318.63 / $772.44	Professional		$112.10	$318.63	$772.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.01 / $93.93 / $227.72	Professional	26	$74.01	$93.93	$227.72
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.03 / $224.70 / $544.72	Professional	TC	$177.03	$224.70	$544.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $64.41 / $170.56 / $333.12	Professional		$64.41	$170.56	$333.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $67.54 / $67.54 / $67.54	Facility	26	$67.54	$67.54	$67.54
Providence Facility/Professional Professional Modifier Low / Median / High Price $180.13 / $325.00 / $607.36	Professional		$180.13	$325.00	$607.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $49.58 / $75.48 / $129.35	Professional	26	$49.58	$75.48	$129.35
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $119.14 / $210.72 / $477.68	Professional	TC	$119.14	$210.72	$477.68
United Facility/Professional Professional Modifier Low / Median / High Price $200.32 / $286.45 / $515.95	Professional		$200.32	$286.45	$515.95
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.30 / $70.37 / $120.48	Professional	26	$56.30	$70.37	$120.48
United Facility/Professional Professional Modifier TC Low / Median / High Price $140.51 / $212.06 / $371.93	Professional	TC	$140.51	$212.06	$371.93
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $164.81 / $184.68 / $262.29	Professional		$164.81	$184.68	$262.29
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.59 / $56.00 / $77.27	Professional	26	$48.59	$56.00	$77.27
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $116.23 / $135.84 / $1,100.00	Professional	TC	$116.23	$135.84	$1,100.00