Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.82 / $57.85 / $76.19	Facility	26	$47.82	$57.85	$76.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.44 / $206.38 / $450.50	Professional		$153.44	$206.38	$450.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.29 / $59.84 / $112.29	Professional	26	$49.29	$59.84	$112.29
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $101.38 / $136.88 / $299.24	Professional	TC	$101.38	$136.88	$299.24
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $221.11 / $221.11 / $282.91	Professional		$221.11	$221.11	$282.91
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $76.37 / $106.12	Professional	26	$43.54	$76.37	$106.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.33 / $133.35 / $211.16	Professional		$49.33	$133.35	$211.16
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $158.96 / $217.05 / $260.42	Professional		$158.96	$217.05	$260.42
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $53.87 / $53.87 / $58.25	Professional	26	$53.87	$53.87	$58.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Cigna Facility/Professional Professional Modifier Low / Median / High Price $142.62 / $257.06 / $504.56	Professional		$142.62	$257.06	$504.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.10 / $65.91 / $120.00	Professional	26	$44.10	$65.91	$120.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $94.54 / $186.23 / $387.57	Professional	TC	$94.54	$186.23	$387.57
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $417.20 / $525.76 / $540.32	Facility	26	$417.20	$525.76	$540.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,882.38 / $1,938.85 / $1,938.85	Professional		$1,882.38	$1,938.85	$1,938.85
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.24 / $434.24 / $459.75	Professional	26	$434.24	$434.24	$459.75
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 $158.96 / $273.80 / $427.05	Professional		$158.96	$273.80	$427.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.90 / $91.26 / $221.24	Professional	26	$71.90	$91.26	$221.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $143.82 / $182.54 / $442.52	Professional	TC	$143.82	$182.54	$442.52
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $62.41 / $134.22 / $282.91	Professional		$62.41	$134.22	$282.91
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.98 / $65.98 / $65.98	Facility	26	$65.98	$65.98	$65.98
Providence Facility/Professional Professional Modifier Low / Median / High Price $148.91 / $290.45 / $517.00	Professional		$148.91	$290.45	$517.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.79 / $62.25 / $117.50	Professional	26	$47.79	$62.25	$117.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $94.54 / $180.98 / $390.21	Professional	TC	$94.54	$180.98	$390.21
United Facility/Professional Professional Modifier Low / Median / High Price $168.72 / $241.80 / $424.37	Professional		$168.72	$241.80	$424.37
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.28 / $62.44 / $106.40	Professional	26	$49.28	$62.44	$106.40
United Facility/Professional Professional Modifier TC Low / Median / High Price $115.64 / $169.56 / $307.60	Professional	TC	$115.64	$169.56	$307.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.62 / $158.96 / $225.40	Professional		$141.62	$158.96	$225.40
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.21 / $54.42 / $75.13	Professional	26	$47.21	$54.42	$75.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $94.42 / $110.34 / $1,100.00	Professional	TC	$94.42	$110.34	$1,100.00