Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $67.12 / $104.40 / $126.65	Facility	26	$67.12	$104.40	$126.65
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $385.48 / $638.00	Professional		$250.00	$385.48	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.12 / $106.60 / $154.00	Professional	26	$67.12	$106.60	$154.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $186.02 / $272.47 / $443.03	Professional	TC	$186.02	$272.47	$443.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $176.94 / $176.94 / $186.98	Professional		$176.94	$176.94	$186.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $61.86 / $65.67 / $77.33	Professional	26	$61.86	$65.67	$77.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $107.28 / $207.70 / $349.62	Professional		$107.28	$207.70	$349.62
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $252.77 / $290.69 / $361.00	Professional		$252.77	$290.69	$361.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $76.54 / $76.54 / $83.19	Professional	26	$76.54	$76.54	$83.19
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Cigna Facility/Professional Professional Modifier Low / Median / High Price $227.06 / $440.75 / $866.98	Professional		$227.06	$440.75	$866.98
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $63.49 / $98.36 / $174.00	Professional	26	$63.49	$98.36	$174.00
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $158.74 / $322.00 / $714.84	Professional	TC	$158.74	$322.00	$714.84
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $593.12 / $746.48 / $764.32	Facility	26	$593.12	$746.48	$764.32
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,389.77 / $3,491.47 / $3,491.47	Professional		$3,389.77	$3,491.47	$3,491.47
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $657.14 / $657.14 / $657.14	Professional	26	$657.14	$657.14	$657.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,953.83 / $3,042.45 / $3,042.45	Professional	TC	$2,953.83	$3,042.45	$3,042.45
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $330.34 / $436.05 / $647.22	Professional		$330.34	$436.05	$647.22
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $102.18 / $129.69 / $314.39	Professional	26	$102.18	$129.69	$314.39
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $241.37 / $306.36 / $742.68	Professional	TC	$241.37	$306.36	$742.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $88.47 / $233.28 / $505.54	Professional		$88.47	$233.28	$505.54
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $93.41 / $93.41 / $93.41	Facility	26	$93.41	$93.41	$93.41
Providence Facility/Professional Professional Modifier Low / Median / High Price $242.05 / $470.05 / $861.04	Professional		$242.05	$470.05	$861.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $68.43 / $98.36 / $171.38	Professional	26	$68.43	$98.36	$171.38
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $165.89 / $311.81 / $714.84	Professional	TC	$165.89	$311.81	$714.84
United Facility/Professional Professional Modifier Low / Median / High Price $267.35 / $415.28 / $699.99	Professional		$267.35	$415.28	$699.99
United Facility/Professional Professional Modifier 26 Low / Median / High Price $70.54 / $88.78 / $168.68	Professional	26	$70.54	$88.78	$168.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $192.64 / $323.54 / $593.34	Professional	TC	$192.64	$323.54	$593.34
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $225.55 / $252.77 / $358.94	Professional		$225.55	$252.77	$358.94
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.08 / $77.33 / $106.70	Professional	26	$67.08	$77.33	$106.70
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $158.46 / $185.20 / $1,400.00	Professional	TC	$158.46	$185.20	$1,400.00