Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.42 / $52.93 / $67.72	Facility	26	$42.42	$52.93	$67.72
Aetna Facility/Professional Professional Modifier Low / Median / High Price $124.41 / $158.00 / $325.00	Professional		$124.41	$158.00	$325.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.61 / $53.84 / $114.34	Professional	26	$44.61	$53.84	$114.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.28 / $98.24 / $175.99	Professional	TC	$79.28	$98.24	$175.99
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.20 / $114.38 / $164.69	Professional		$100.20	$114.38	$164.69
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.69 / $53.21 / $94.31	Professional	26	$38.69	$53.21	$94.31
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $65.29 / $153.93 / $153.93	Professional	TC	$65.29	$153.93	$153.93
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.01 / $105.40 / $168.13	Professional		$42.01	$105.40	$168.13
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $129.97 / $163.60 / $231.35	Professional		$129.97	$163.60	$231.35
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $47.88 / $50.36 / $132.31	Professional	26	$47.88	$50.36	$132.31
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 $115.50 / $171.95 / $298.44	Professional		$115.50	$171.95	$298.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.67 / $57.57 / $104.35	Professional	26	$38.67	$57.57	$104.35
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.45 / $103.65 / $191.47	Professional	TC	$72.45	$103.65	$191.47
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 $915.52 / $915.52 / $1,167.08	Professional		$915.52	$915.52	$1,167.08
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $323.73 / $323.73 / $409.43	Professional	26	$323.73	$323.73	$409.43
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $591.79 / $591.79 / $757.65	Professional	TC	$591.79	$591.79	$757.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.20 / $228.89 / $501.80	Professional		$123.20	$228.89	$501.80
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 $112.28 / $142.51 / $207.88	Professional	TC	$112.28	$142.51	$207.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.34 / $107.84 / $234.01	Professional		$54.34	$107.84	$234.01
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 $119.32 / $194.65 / $380.03	Professional		$119.32	$194.65	$380.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $41.11 / $55.28 / $102.71	Professional	26	$41.11	$55.28	$102.71
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $73.81 / $101.50 / $185.46	Professional	TC	$73.81	$101.50	$185.46
United Facility/Professional Professional Modifier Low / Median / High Price $125.46 / $157.85 / $268.72	Professional		$125.46	$157.85	$268.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.60 / $54.42 / $96.08	Professional	26	$43.60	$54.42	$96.08
United Facility/Professional Professional Modifier TC Low / Median / High Price $82.86 / $103.43 / $181.25	Professional	TC	$82.86	$103.43	$181.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $115.67 / $129.97 / $184.05	Professional		$115.67	$129.97	$184.05
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 $73.70 / $86.13 / $1,100.00	Professional	TC	$73.70	$86.13	$1,100.00