Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.54 / $56.78 / $73.75	Facility	26	$45.54	$56.78	$73.75
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.10 / $267.55 / $493.42	Professional		$195.10	$267.55	$493.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.73 / $58.32 / $172.70	Professional	26	$47.73	$58.32	$172.70
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.56 / $200.88 / $333.10	Professional	TC	$149.56	$200.88	$333.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $157.63 / $170.91 / $229.19	Professional		$157.63	$170.91	$229.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.50 / $57.06 / $101.15	Professional	26	$41.50	$57.06	$101.15
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $180.15 / $180.15 / $225.51	Professional	TC	$180.15	$180.15	$225.51
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.03 / $162.44 / $265.50	Professional		$45.03	$162.44	$265.50
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $212.95 / $266.19 / $425.90	Professional		$212.95	$266.19	$425.90
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.35 / $51.35 / $55.49	Professional	26	$51.35	$51.35	$55.49
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.28 / $291.14 / $513.71	Professional		$190.28	$291.14	$513.71
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.69 / $65.55 / $114.31	Professional	26	$42.69	$65.55	$114.31
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.74 / $216.80 / $398.00	Professional	TC	$144.74	$216.80	$398.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $397.76 / $501.04 / $514.88	Facility	26	$397.76	$501.04	$514.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,817.09 / $1,871.61 / $1,931.70	Professional		$1,817.09	$1,871.61	$1,931.70
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $364.90 / $364.90 / $438.60	Professional	26	$364.90	$364.90	$438.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,526.12 / $1,571.91 / $1,571.91	Professional	TC	$1,526.12	$1,571.91	$1,571.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $97.11 / $368.26 / $692.24	Professional		$97.11	$368.26	$692.24
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $68.54 / $86.99 / $210.88	Professional	26	$68.54	$86.99	$210.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $221.61 / $281.27 / $681.88	Professional	TC	$221.61	$281.27	$681.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.62 / $213.79 / $409.43	Professional		$63.62	$213.79	$409.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.89 / $62.89 / $62.89	Facility	26	$62.89	$62.89	$62.89
Providence Facility/Professional Professional Modifier Low / Median / High Price $196.61 / $319.43 / $633.67	Professional		$196.61	$319.43	$633.67
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.86 / $64.89 / $110.92	Professional	26	$45.86	$64.89	$110.92
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $145.55 / $210.09 / $397.80	Professional	TC	$145.55	$210.09	$397.80
United Facility/Professional Professional Modifier Low / Median / High Price $204.95 / $272.52 / $466.96	Professional		$204.95	$272.52	$466.96
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.35 / $59.19 / $109.89	Professional	26	$47.35	$59.19	$109.89
United Facility/Professional Professional Modifier TC Low / Median / High Price $149.26 / $205.24 / $362.13	Professional	TC	$149.26	$205.24	$362.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.49 / $212.95 / $303.22	Professional		$190.49	$212.95	$303.22
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.99 / $51.87 / $71.59	Professional	26	$44.99	$51.87	$71.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $145.49 / $170.06 / $1,100.00	Professional	TC	$145.49	$170.06	$1,100.00