Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.45 / $90.71 / $106.93	Facility	26	$57.45	$90.71	$106.93
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.96 / $323.47 / $642.44	Professional		$185.96	$323.47	$642.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $111.15 / $254.90	Professional	26	$62.50	$111.15	$254.90
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $113.60 / $203.95 / $422.10	Professional	TC	$113.60	$203.95	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $126.14 / $160.04 / $320.08	Professional		$126.14	$160.04	$320.08
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.06 / $73.11 / $129.66	Professional	26	$52.06	$73.11	$129.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $90.96 / $90.96 / $113.70	Professional	TC	$90.96	$90.96	$113.70
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.67 / $153.24 / $242.86	Professional		$57.67	$153.24	$242.86
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $180.20 / $270.30 / $425.39	Professional		$180.20	$270.30	$425.39
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $65.81 / $68.31 / $69.75	Professional	26	$65.81	$68.31	$69.75
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 $161.66 / $358.08 / $732.15	Professional		$161.66	$358.08	$732.15
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.46 / $89.00 / $154.38	Professional	26	$55.46	$89.00	$154.38
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $102.81 / $232.48 / $589.99	Professional	TC	$102.81	$232.48	$589.99
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 $3,174.82 / $3,270.06 / $3,270.06	Professional		$3,174.82	$3,270.06	$3,270.06
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $609.25 / $609.25 / $609.25	Professional	26	$609.25	$609.25	$609.25
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,772.01 / $2,855.17 / $2,855.17	Professional	TC	$2,772.01	$2,855.17	$2,855.17
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $123.01 / $281.89 / $813.21	Professional		$123.01	$281.89	$813.21
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 $156.43 / $198.54 / $481.32	Professional	TC	$156.43	$198.54	$481.32
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.75 / $145.31 / $315.35	Professional		$74.75	$145.31	$315.35
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 $168.59 / $375.00 / $723.83	Professional		$168.59	$375.00	$723.83
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.86 / $89.00 / $153.90	Professional	26	$58.86	$89.00	$153.90
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $105.25 / $240.71 / $584.41	Professional	TC	$105.25	$240.71	$584.41
United Facility/Professional Professional Modifier Low / Median / High Price $187.43 / $264.61 / $577.52	Professional		$187.43	$264.61	$577.52
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.92 / $76.15 / $148.49	Professional	26	$60.92	$76.15	$148.49
United Facility/Professional Professional Modifier TC Low / Median / High Price $122.70 / $173.23 / $413.25	Professional	TC	$122.70	$173.23	$413.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $160.38 / $180.20 / $255.23	Professional		$160.38	$180.20	$255.23
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 $102.70 / $120.03 / $1,400.00	Professional	TC	$102.70	$120.03	$1,400.00