Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.82 / $59.84 / $74.25	Facility	26	$47.82	$59.84	$74.25
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.31 / $272.49 / $450.00	Professional		$199.31	$272.49	$450.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.00 / $59.78 / $89.79	Professional	26	$50.00	$59.78	$89.79
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.43 / $206.08 / $357.10	Professional	TC	$149.43	$206.08	$357.10
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $155.78 / $199.81 / $235.27	Professional		$155.78	$199.81	$235.27
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.54 / $54.42 / $106.12	Professional	26	$43.54	$54.42	$106.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.88 / $164.55 / $260.22	Professional		$47.88	$164.55	$260.22
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $160.00 / $160.00 / $160.00	Professional		$160.00	$160.00	$160.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $53.87 / $57.50 / $167.91	Professional	26	$53.87	$57.50	$167.91
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $211.29 / $328.11 / $613.79	Professional		$211.29	$328.11	$613.79
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.54 / $68.77 / $123.00	Professional	26	$44.54	$68.77	$123.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $163.19 / $255.64 / $488.98	Professional	TC	$163.19	$255.64	$488.98
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $417.20 / $525.76 / $537.20	Facility	26	$417.20	$525.76	$537.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,195.67 / $2,261.56 / $2,261.56	Professional		$2,195.67	$2,261.56	$2,261.56
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $439.20 / $439.20 / $459.75	Professional	26	$439.20	$439.20	$459.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,890.23 / $1,946.93 / $1,946.93	Professional	TC	$1,890.23	$1,946.93	$1,946.93
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $308.10 / $406.69 / $610.65	Professional		$308.10	$406.69	$610.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.90 / $91.26 / $221.24	Professional	26	$71.90	$91.26	$221.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $248.52 / $315.43 / $764.68	Professional	TC	$248.52	$315.43	$764.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $66.76 / $240.00 / $452.98	Professional		$66.76	$240.00	$452.98
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $221.51 / $366.05 / $719.53	Professional		$221.51	$366.05	$719.53
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.08 / $67.88 / $119.10	Professional	26	$48.08	$67.88	$119.10
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $163.19 / $251.90 / $485.50	Professional	TC	$163.19	$251.90	$485.50
United Facility/Professional Professional Modifier Low / Median / High Price $225.31 / $314.35 / $552.90	Professional		$225.31	$314.35	$552.90
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.28 / $62.44 / $106.41	Professional	26	$49.28	$62.44	$106.41
United Facility/Professional Professional Modifier TC Low / Median / High Price $176.08 / $248.89 / $428.02	Professional	TC	$176.08	$248.89	$428.02
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $199.05 / $222.54 / $316.86	Professional		$199.05	$222.54	$316.86
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.21 / $54.42 / $75.13	Professional	26	$47.21	$54.42	$75.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.84 / $177.49 / $1,100.00	Professional	TC	$151.84	$177.49	$1,100.00