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 / $65.67	Facility	26	$39.29	$49.09	$65.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $115.98 / $171.00 / $436.50	Professional		$115.98	$171.00	$436.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.34 / $51.30 / $136.04	Professional	26	$41.34	$51.30	$136.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.50 / $110.56 / $240.00	Professional	TC	$75.50	$110.56	$240.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $94.63 / $122.20 / $217.16	Professional		$94.63	$122.20	$217.16
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.65 / $62.51 / $86.89	Professional	26	$35.65	$62.51	$86.89
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.44 / $108.48 / $167.11	Professional		$38.44	$108.48	$167.11
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $116.09 / $166.74 / $244.40	Professional		$116.09	$166.74	$244.40
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $42.78 / $44.11 / $47.60	Professional	26	$42.78	$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 $109.51 / $210.00 / $417.93	Professional		$109.51	$210.00	$417.93
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.67 / $59.44 / $102.63	Professional	26	$36.67	$59.44	$102.63
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.16 / $147.00 / $308.64	Professional	TC	$70.16	$147.00	$308.64
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 $681.00 / $1,657.60 / $1,657.60	Professional		$681.00	$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 $1,345.00 / $1,357.90 / $1,357.90	Professional	TC	$1,345.00	$1,357.90	$1,357.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $78.72 / $186.63 / $509.80	Professional		$78.72	$186.63	$509.80
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 $106.81 / $135.56 / $328.64	Professional	TC	$106.81	$135.56	$328.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $51.03 / $102.85 / $219.54	Professional		$51.03	$102.85	$219.54
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 $120.29 / $228.69 / $412.03	Professional		$120.29	$228.69	$412.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $58.46 / $98.69	Professional	26	$39.36	$58.46	$98.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $71.37 / $147.00 / $308.64	Professional	TC	$71.37	$147.00	$308.64
United Facility/Professional Professional Modifier Low / Median / High Price $135.61 / $199.92 / $352.80	Professional		$135.61	$199.92	$352.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.00 / $51.25 / $92.25	Professional	26	$41.00	$51.25	$92.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $137.36 / $265.61	Professional	TC	$90.19	$137.36	$265.61
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $108.77 / $122.20 / $173.15	Professional		$108.77	$122.20	$173.15
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 $70.12 / $81.96 / $1,100.00	Professional	TC	$70.12	$81.96	$1,100.00