Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.73 / $90.71 / $195.81	Facility	26	$57.73	$90.71	$195.81
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.06 / $322.88 / $700.00	Professional		$185.06	$322.88	$700.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $64.87 / $109.71 / $237.00	Professional	26	$64.87	$109.71	$237.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $92.53 / $137.50 / $285.49	Professional	52	$92.53	$137.50	$285.49
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $108.85 / $195.02 / $422.10	Professional	TC	$108.85	$195.02	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $125.92 / $158.31 / $319.52	Professional		$125.92	$158.31	$319.52
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $73.14 / $129.66	Professional	26	$53.20	$73.14	$129.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $79.38 / $90.72 / $113.40	Professional	TC	$79.38	$90.72	$113.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.67 / $156.99 / $245.27	Professional		$57.67	$156.99	$245.27
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $179.89 / $251.85 / $424.67	Professional		$179.89	$251.85	$424.67
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $65.81 / $69.75 / $102.46	Professional	26	$65.81	$69.75	$102.46
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.40 / $357.59 / $718.20	Professional		$161.40	$357.59	$718.20
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.46 / $89.00 / $154.49	Professional	26	$55.46	$89.00	$154.49
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.53 / $232.48 / $564.34	Professional	TC	$102.53	$232.48	$564.34
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $510.16 / $641.91 / $656.72	Facility	26	$510.16	$641.91	$656.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,608.75 / $2,988.88 / $2,988.88	Professional		$1,608.75	$2,988.88	$2,988.88
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $558.07 / $558.07 / $563.25	Professional	26	$558.07	$558.07	$563.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,498.98 / $2,573.94 / $2,573.94	Professional	TC	$2,498.98	$2,573.94	$2,573.94
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $118.04 / $301.89 / $780.00	Professional		$118.04	$301.89	$780.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $87.88 / $111.54 / $270.39	Professional	26	$87.88	$111.54	$270.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $156.01 / $198.02 / $480.04	Professional	TC	$156.01	$198.02	$480.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.75 / $145.61 / $315.37	Professional		$74.75	$145.61	$315.37
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Providence Facility/Professional Professional Modifier Low / Median / High Price $168.87 / $375.00 / $698.47	Professional		$168.87	$375.00	$698.47
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.86 / $89.00 / $153.76	Professional	26	$58.86	$89.00	$153.76
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $105.53 / $240.71 / $562.66	Professional	TC	$105.53	$240.71	$562.66
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $286.66 / $577.52	Professional		$187.43	$286.66	$577.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.92 / $76.15 / $144.29	Professional	26	$60.92	$76.15	$144.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $178.94 / $391.35	Professional	TC	$122.70	$178.94	$391.35
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $160.12 / $179.89 / $254.80	Professional		$160.12	$179.89	$254.80
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.69 / $66.48 / $91.76	Professional	26	$57.69	$66.48	$91.76
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $102.42 / $119.70 / $1,400.00	Professional	TC	$102.42	$119.70	$1,400.00