Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.29 / $49.09 / $66.84	Facility	26	$39.29	$49.09	$66.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.60 / $167.73 / $375.00	Professional		$117.60	$167.73	$375.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.34 / $51.30 / $114.54	Professional	26	$41.34	$51.30	$114.54
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.79 / $105.79 / $231.46	Professional	TC	$75.79	$105.79	$231.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $42.88 / $103.33 / $170.40	Professional		$42.88	$103.33	$170.40
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $52.45 / $86.89	Professional	26	$35.65	$52.45	$86.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $166.04 / $166.04 / $166.04	Professional	TC	$166.04	$166.04	$166.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.44 / $103.71 / $159.11	Professional		$38.44	$103.71	$159.11
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $122.15 / $167.15 / $245.00	Professional		$122.15	$167.15	$245.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.11 / $47.60 / $94.55	Professional	26	$44.11	$47.60	$94.55
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 $109.79 / $203.36 / $423.34	Professional		$109.79	$203.36	$423.34
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $35.90 / $56.41 / $106.68	Professional	26	$35.90	$56.41	$106.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.43 / $144.83 / $311.37	Professional	TC	$70.43	$144.83	$311.37
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 $941.85 / $1,657.60 / $1,657.60	Professional		$941.85	$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 $1,318.35 / $1,357.90 / $1,357.90	Professional	TC	$1,318.35	$1,357.90	$1,357.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $78.98 / $191.66 / $365.95	Professional		$78.98	$191.66	$365.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.73 / $191.66	Professional	26	$58.88	$74.73	$191.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.22 / $136.09 / $329.92	Professional	TC	$107.22	$136.09	$329.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.93 / $103.28 / $220.09	Professional		$50.93	$103.28	$220.09
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 $114.59 / $232.13 / $413.75	Professional		$114.59	$232.13	$413.75
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.13 / $54.22 / $102.63	Professional	26	$39.13	$54.22	$102.63
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.43 / $141.19 / $318.00	Professional	TC	$70.43	$141.19	$318.00
United Facility/Professional Professional Modifier Low / Median / High Price $134.36 / $192.23 / $355.66	Professional		$134.36	$192.23	$355.66
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.19 / $51.25 / $95.77	Professional	26	$41.19	$51.25	$95.77
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.80 / $138.86 / $264.17	Professional	TC	$90.80	$138.86	$264.17
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.05 / $122.50 / $173.58	Professional		$109.05	$122.50	$173.58
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 $70.39 / $82.29 / $1,100.00	Professional	TC	$70.39	$82.29	$1,100.00