Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.73 / $89.76 / $108.96	Facility	26	$57.73	$89.76	$108.96
Aetna Facility/Professional Professional Modifier Low / Median / High Price $185.36 / $334.57 / $700.00	Professional		$185.36	$334.57	$700.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $65.73 / $111.86 / $263.89	Professional	26	$65.73	$111.86	$263.89
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $92.68 / $143.38 / $300.00	Professional	52	$92.68	$143.38	$300.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.13 / $199.63 / $422.10	Professional	TC	$109.13	$199.63	$422.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.40 / $165.18 / $297.83	Professional		$144.40	$165.18	$297.83
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $53.20 / $69.65 / $129.66	Professional	26	$53.20	$69.65	$129.66
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $91.21 / $91.21 / $114.01	Professional	TC	$91.21	$91.21	$114.01
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.67 / $161.63 / $250.89	Professional		$57.67	$161.63	$250.89
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $180.50 / $284.08 / $525.00	Professional		$180.50	$284.08	$525.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $65.81 / $70.09 / $102.72	Professional	26	$65.81	$70.09	$102.72
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.94 / $357.67 / $732.78	Professional		$161.94	$357.67	$732.78
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.88 / $85.36 / $153.81	Professional	26	$55.88	$85.36	$153.81
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $103.09 / $233.07 / $589.42	Professional	TC	$103.09	$233.07	$589.42
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $510.16 / $641.91 / $659.84	Facility	26	$510.16	$641.91	$659.84
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,508.76 / $3,240.21 / $3,240.21	Professional		$1,508.76	$3,240.21	$3,240.21
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $577.89 / $577.89 / $577.89	Professional	26	$577.89	$577.89	$577.89
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 $111.06 / $268.83 / $880.45	Professional		$111.06	$268.83	$880.45
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 $156.85 / $199.07 / $482.60	Professional	TC	$156.85	$199.07	$482.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.77 / $146.40 / $316.43	Professional		$74.77	$146.40	$316.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $80.59 / $80.59 / $80.59	Facility	26	$80.59	$80.59	$80.59
Providence Facility/Professional Professional Modifier Low / Median / High Price $169.44 / $375.00 / $714.22	Professional		$169.44	$375.00	$714.22
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.86 / $85.14 / $150.00	Professional	26	$58.86	$85.14	$150.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.76 / $240.71 / $583.76	Professional	TC	$104.76	$240.71	$583.76
United Facility/Professional Professional Modifier Low / Median / High Price $187.74 / $287.13 / $578.46	Professional		$187.74	$287.13	$578.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $60.23 / $76.15 / $144.69	Professional	26	$60.23	$76.15	$144.69
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.01 / $188.13 / $412.94	Professional	TC	$123.01	$188.13	$412.94
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $160.66 / $180.50 / $255.68	Professional		$160.66	$180.50	$255.68
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 $102.97 / $120.35 / $1,400.00	Professional	TC	$102.97	$120.35	$1,400.00