Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.11 / $60.19 / $76.62	Facility	26	$48.11	$60.19	$76.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $155.97 / $213.64 / $451.52	Professional		$155.97	$213.64	$451.52
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.61 / $60.19 / $131.24	Professional	26	$50.61	$60.19	$131.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $103.42 / $141.82 / $299.64	Professional	TC	$103.42	$141.82	$299.64
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $285.63 / $285.63 / $285.63	Professional		$285.63	$285.63	$285.63
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.78 / $90.22 / $106.71	Professional	26	$43.78	$90.22	$106.71
BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.58 / $125.57 / $212.70	Professional		$49.58	$125.57	$212.70
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $168.55 / $256.77 / $320.95	Professional		$168.55	$256.77	$320.95
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $54.17 / $54.17 / $58.25	Professional	26	$54.17	$54.17	$58.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Cigna Facility/Professional Professional Modifier Low / Median / High Price $144.11 / $258.19 / $504.56	Professional		$144.11	$258.19	$504.56
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.37 / $65.91 / $120.00	Professional	26	$44.37	$65.91	$120.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.64 / $186.23 / $389.48	Professional	TC	$95.64	$186.23	$389.48
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $419.92 / $528.08 / $542.79	Facility	26	$419.92	$528.08	$542.79
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $835.00 / $1,941.31 / $1,941.31	Professional		$835.00	$1,941.31	$1,941.31
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $434.24 / $434.24 / $463.80	Professional	26	$434.24	$434.24	$463.80
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,950.00 / $1,950.00 / $1,950.00	Professional	TC	$1,950.00	$1,950.00	$1,950.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $127.56 / $276.45 / $427.05	Professional		$127.56	$276.45	$427.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $72.33 / $91.81 / $222.56	Professional	26	$72.33	$91.81	$222.56
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $145.50 / $184.67 / $447.68	Professional	TC	$145.50	$184.67	$447.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $62.88 / $139.46 / $285.64	Professional		$62.88	$139.46	$285.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $66.34 / $66.34 / $66.34	Facility	26	$66.34	$66.34	$66.34
Providence Facility/Professional Professional Modifier Low / Median / High Price $150.05 / $291.81 / $520.76	Professional		$150.05	$291.81	$520.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.07 / $62.49 / $117.50	Professional	26	$48.07	$62.49	$117.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $95.64 / $180.98 / $392.13	Professional	TC	$95.64	$180.98	$392.13
United Facility/Professional Professional Modifier Low / Median / High Price $169.95 / $243.69 / $443.04	Professional		$169.95	$243.69	$443.04
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.60 / $62.44 / $106.15	Professional	26	$49.60	$62.44	$106.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $116.88 / $175.31 / $303.54	Professional	TC	$116.88	$175.31	$303.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $143.00 / $160.47 / $227.54	Professional		$143.00	$160.47	$227.54
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.49 / $54.73 / $75.51	Professional	26	$47.49	$54.73	$75.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.52 / $111.63 / $1,100.00	Professional	TC	$95.52	$111.63	$1,100.00