Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.96 / $62.59 / $80.98	Facility	26	$49.96	$62.59	$80.98
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.82 / $235.83 / $406.55	Professional		$173.82	$235.83	$406.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $61.49 / $93.47	Professional	26	$51.30	$61.49	$93.47
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $123.86 / $167.82 / $325.76	Professional	TC	$123.86	$167.82	$325.76
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $195.84 / $195.84 / $195.84	Professional		$195.84	$195.84	$195.84
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.15 / $62.31 / $110.46	Professional	26	$48.15	$62.31	$110.46
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.62 / $152.05 / $242.36	Professional		$51.62	$152.05	$242.36
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $185.33 / $203.86 / $229.00	Professional		$185.33	$203.86	$229.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.07 / $56.07 / $60.33	Professional	26	$56.07	$56.07	$60.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Cigna Facility/Professional Professional Modifier Low / Median / High Price $166.46 / $302.76 / $600.13	Professional		$166.46	$302.76	$600.13
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.63 / $71.55 / $124.28	Professional	26	$46.63	$71.55	$124.28
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $116.32 / $225.80 / $481.77	Professional	TC	$116.32	$225.80	$481.77
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $434.48 / $546.72 / $561.91	Facility	26	$434.48	$546.72	$561.91
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,293.84 / $2,362.66 / $2,362.66	Professional		$2,293.84	$2,362.66	$2,362.66
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $523.40 / $523.40 / $523.40	Professional	26	$523.40	$523.40	$523.40
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,412.00 / $2,412.00 / $2,412.00	Professional	TC	$2,412.00	$2,412.00	$2,412.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $242.20 / $319.70 / $469.79	Professional		$242.20	$319.70	$469.79
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $74.84 / $95.01 / $230.32	Professional	26	$74.84	$95.01	$230.32
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $177.03 / $224.70 / $544.72	Professional	TC	$177.03	$224.70	$544.72
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $65.03 / $164.64 / $330.53	Professional		$65.03	$164.64	$330.53
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $68.70 / $68.70 / $68.70	Facility	26	$68.70	$68.70	$68.70
Providence Facility/Professional Professional Modifier Low / Median / High Price $177.78 / $325.00 / $608.07	Professional		$177.78	$325.00	$608.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.14 / $70.84 / $123.00	Professional	26	$50.14	$70.84	$123.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $119.70 / $219.34 / $482.23	Professional	TC	$119.70	$219.34	$482.23
United Facility/Professional Professional Modifier Low / Median / High Price $204.35 / $286.08 / $511.85	Professional		$204.35	$286.08	$511.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.68 / $64.59 / $109.82	Professional	26	$51.68	$64.59	$109.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $142.94 / $218.63 / $352.22	Professional	TC	$142.94	$218.63	$352.22
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.37 / $185.33 / $263.17	Professional		$165.37	$185.33	$263.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.14 / $56.65 / $78.15	Professional	26	$49.14	$56.65	$78.15
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $116.23 / $135.84 / $1,100.00	Professional	TC	$116.23	$135.84	$1,100.00