Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.29 / $47.99 / $63.67	Facility	26	$39.29	$47.99	$63.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.90 / $171.00 / $375.00	Professional		$117.90	$171.00	$375.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.81 / $51.45 / $167.27	Professional	26	$41.81	$51.45	$167.27
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $76.06 / $106.18 / $240.00	Professional	TC	$76.06	$106.18	$240.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.10 / $103.32 / $218.26	Professional		$95.10	$103.32	$218.26
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $54.85 / $86.89	Professional	26	$35.65	$54.85	$86.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $66.55 / $66.55 / $123.01	Professional	TC	$66.55	$66.55	$123.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.44 / $109.02 / $168.79	Professional		$38.44	$109.02	$168.79
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $122.81 / $184.22 / $245.62	Professional		$122.81	$184.22	$245.62
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.90 / $44.11 / $47.60	Professional	26	$37.90	$44.11	$47.60
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $110.07 / $210.00 / $416.80	Professional		$110.07	$210.00	$416.80
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.88 / $60.19 / $106.68	Professional	26	$37.88	$60.19	$106.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.70 / $147.00 / $310.02	Professional	TC	$70.70	$147.00	$310.02
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $341.52 / $430.56 / $442.24	Facility	26	$341.52	$430.56	$442.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $493.93 / $1,657.60 / $1,657.60	Professional		$493.93	$1,657.60	$1,657.60
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $379.76 / $379.76 / $379.76	Professional	26	$379.76	$379.76	$379.76
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,331.00 / $1,357.90 / $1,357.90	Professional	TC	$1,331.00	$1,357.90	$1,357.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $61.41 / $139.75 / $369.20	Professional		$61.41	$139.75	$369.20
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.73 / $181.16	Professional	26	$58.88	$74.73	$181.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.65 / $136.63 / $331.24	Professional	TC	$107.65	$136.63	$331.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.93 / $103.26 / $221.73	Professional		$50.93	$103.26	$221.73
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $120.84 / $233.08 / $414.06	Professional		$120.84	$233.08	$414.06
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $58.46 / $99.77	Professional	26	$39.36	$58.46	$99.77
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.20 / $147.00 / $310.02	Professional	TC	$72.20	$147.00	$310.02
United Facility/Professional Professional Modifier Low / Median / High Price $138.94 / $201.54 / $365.22	Professional		$138.94	$201.54	$365.22
United Facility/Professional Professional Modifier 26 Low / Median / High Price $43.27 / $52.08 / $97.11	Professional	26	$43.27	$52.08	$97.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.56 / $138.86 / $252.00	Professional	TC	$91.56	$138.86	$252.00
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.32 / $122.81 / $174.03	Professional		$109.32	$122.81	$174.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $44.56 / $61.51	Professional	26	$38.65	$44.56	$61.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $70.68 / $82.61 / $1,100.00	Professional	TC	$70.68	$82.61	$1,100.00