Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.89 / $89.41 / $107.37	Facility	26	$56.89	$89.41	$107.37
Aetna Facility/Professional Professional Modifier Low / Median / High Price $224.06 / $383.50 / $746.66	Professional		$224.06	$383.50	$746.66
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $105.88 / $220.90	Professional	26	$62.50	$105.88	$220.90
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $112.03 / $163.55 / $284.62	Professional	52	$112.03	$163.55	$284.62
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $159.28 / $260.33 / $440.00	Professional	TC	$159.28	$260.33	$440.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $171.76 / $188.94 / $336.12	Professional		$171.76	$188.94	$336.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.43 / $80.68 / $127.81	Professional	26	$52.43	$80.68	$127.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.84 / $182.47 / $281.29	Professional		$56.84	$182.47	$281.29
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $214.58 / $271.04 / $429.40	Professional		$214.58	$271.04	$429.40
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $64.88 / $64.88 / $69.83	Professional	26	$64.88	$64.88	$69.83
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $196.74 / $381.40 / $767.33	Professional		$196.74	$381.40	$767.33
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $55.11 / $82.82 / $150.00	Professional	26	$55.11	$82.82	$150.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.97 / $288.66 / $637.00	Professional	TC	$134.97	$288.66	$637.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $502.88 / $632.64 / $650.32	Facility	26	$502.88	$632.64	$650.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,918.81 / $3,507.01 / $3,612.22	Professional		$2,918.81	$3,507.01	$3,612.22
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $571.29 / $571.29 / $571.29	Professional	26	$571.29	$571.29	$571.29
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,477.29 / $2,539.44 / $2,545.16	Professional	TC	$2,477.29	$2,539.44	$2,545.16
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $152.35 / $370.39 / $897.92	Professional		$152.35	$370.39	$897.92
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.62 / $109.94 / $266.52	Professional	26	$86.62	$109.94	$266.52
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $205.21 / $260.45 / $631.40	Professional	TC	$205.21	$260.45	$631.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.38 / $198.32 / $429.40	Professional		$74.38	$198.32	$429.40
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.45 / $79.45 / $79.45	Facility	26	$79.45	$79.45	$79.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $214.70 / $415.72 / $751.14	Professional		$214.70	$415.72	$751.14
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.03 / $83.37 / $150.00	Professional	26	$58.03	$83.37	$150.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $141.83 / $280.00 / $630.00	Professional	TC	$141.83	$280.00	$630.00
United Facility/Professional Professional Modifier Low / Median / High Price $229.76 / $377.38 / $682.94	Professional		$229.76	$377.38	$682.94
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.27 / $75.06 / $150.13	Professional	26	$59.27	$75.06	$150.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $165.95 / $292.86 / $520.79	Professional	TC	$165.95	$292.86	$520.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $191.59 / $214.70 / $304.92	Professional		$191.59	$214.70	$304.92
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.87 / $65.54 / $90.44	Professional	26	$56.87	$65.54	$90.44
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.72 / $157.47 / $1,400.00	Professional	TC	$134.72	$157.47	$1,400.00