Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.70 / $52.14 / $68.17	Facility	26	$42.70	$52.14	$68.17
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.64 / $171.00 / $516.22	Professional		$120.64	$171.00	$516.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.58 / $54.56 / $121.73	Professional	26	$44.58	$54.56	$121.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $74.36 / $103.99 / $227.00	Professional	TC	$74.36	$103.99	$227.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $88.00 / $132.57 / $223.00	Professional		$88.00	$132.57	$223.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.95 / $53.56 / $94.94	Professional	26	$38.95	$53.56	$94.94
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $53.92 / $61.62 / $61.62	Professional	TC	$53.92	$61.62	$61.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.29 / $107.70 / $166.06	Professional		$42.29	$107.70	$166.06
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $125.72 / $202.41 / $296.57	Professional		$125.72	$202.41	$296.57
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.20 / $48.20 / $52.05	Professional	26	$48.20	$48.20	$52.05
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.69 / $204.58 / $412.00	Professional		$112.69	$204.58	$412.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $40.07 / $61.30 / $107.22	Professional	26	$40.07	$61.30	$107.22
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $69.61 / $138.08 / $296.80	Professional	TC	$69.61	$138.08	$296.80
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $373.44 / $470.00 / $482.96	Facility	26	$373.44	$470.00	$482.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,593.12 / $1,640.91 / $1,640.91	Professional		$1,593.12	$1,640.91	$1,640.91
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $325.83 / $325.83 / $412.05	Professional	26	$325.83	$325.83	$412.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,318.35 / $1,357.90 / $1,357.90	Professional	TC	$1,318.35	$1,357.90	$1,357.90
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $90.85 / $196.50 / $375.73	Professional		$90.85	$196.50	$375.73
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.34 / $81.66 / $197.96	Professional	26	$64.34	$81.66	$197.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $105.96 / $134.49 / $326.04	Professional	TC	$105.96	$134.49	$326.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.68 / $118.46 / $244.24	Professional		$59.68	$118.46	$244.24
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $59.04 / $59.04 / $59.04	Facility	26	$59.04	$59.04	$59.04
Providence Facility/Professional Professional Modifier Low / Median / High Price $116.40 / $215.85 / $404.74	Professional		$116.40	$215.85	$404.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.08 / $60.89 / $104.08	Professional	26	$43.08	$60.89	$104.08
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $69.65 / $139.58 / $289.20	Professional	TC	$69.65	$139.58	$289.20
United Facility/Professional Professional Modifier Low / Median / High Price $125.47 / $178.12 / $329.87	Professional		$125.47	$178.12	$329.87
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.45 / $55.58 / $98.74	Professional	26	$44.45	$55.58	$98.74
United Facility/Professional Professional Modifier TC Low / Median / High Price $78.23 / $114.67 / $221.33	Professional	TC	$78.23	$114.67	$221.33
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $111.80 / $125.72 / $177.94	Professional		$111.80	$125.72	$177.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.24 / $48.69 / $67.19	Professional	26	$42.24	$48.69	$67.19
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.56 / $81.31 / $1,100.00	Professional	TC	$69.56	$81.31	$1,100.00