Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.82 / $59.84 / $76.19	Facility	26	$47.82	$59.84	$76.19
Aetna Facility/Professional Professional Modifier Low / Median / High Price $153.44 / $212.44 / $450.50	Professional		$153.44	$212.44	$450.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.29 / $60.00 / $131.24	Professional	26	$50.29	$60.00	$131.24
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $102.55 / $137.68 / $298.83	Professional	TC	$102.55	$137.68	$298.83
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.05 / $134.09 / $284.01	Professional		$123.05	$134.09	$284.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $89.79 / $106.12	Professional	26	$43.54	$89.79	$106.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.47 / $124.86 / $211.49	Professional		$48.47	$124.86	$211.49
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $167.55 / $255.31 / $319.14	Professional		$167.55	$255.31	$319.14
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 $143.16 / $257.89 / $500.23	Professional		$143.16	$257.89	$500.23
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.79 / $68.91 / $119.81	Professional	26	$44.79	$68.91	$119.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $95.09 / $184.58 / $384.87	Professional	TC	$95.09	$184.58	$384.87
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 $764.00 / $1,938.85 / $1,938.85	Professional		$764.00	$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 $1,906.00 / $1,906.00 / $1,906.00	Professional	TC	$1,906.00	$1,906.00	$1,906.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $126.80 / $274.86 / $399.74	Professional		$126.80	$274.86	$399.74
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 $144.65 / $183.60 / $445.08	Professional	TC	$144.65	$183.60	$445.08
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $62.41 / $134.44 / $282.24	Professional		$62.41	$134.44	$282.24
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 $152.00 / $284.23 / $504.56	Professional		$152.00	$284.23	$504.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.08 / $68.09 / $116.83	Professional	26	$48.08	$68.09	$116.83
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $96.92 / $179.53 / $384.87	Professional	TC	$96.92	$179.53	$384.87
United Facility/Professional Professional Modifier Low / Median / High Price $169.02 / $238.62 / $425.14	Professional		$169.02	$238.62	$425.14
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.28 / $62.44 / $110.64	Professional	26	$49.28	$62.44	$110.64
United Facility/Professional Professional Modifier TC Low / Median / High Price $119.56 / $177.33 / $317.95	Professional	TC	$119.56	$177.33	$317.95
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $142.16 / $159.57 / $226.27	Professional		$142.16	$159.57	$226.27
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 $94.97 / $110.99 / $1,100.00	Professional	TC	$94.97	$110.99	$1,100.00