Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $39.29 / $49.09 / $63.67	Facility	26	$39.29	$49.09	$63.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $130.34 / $180.37 / $353.10	Professional		$130.34	$180.37	$353.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.34 / $51.30 / $129.60	Professional	26	$41.34	$51.30	$129.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $93.24 / $126.89 / $285.00	Professional	TC	$93.24	$126.89	$285.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $120.99 / $128.44 / $201.86	Professional		$120.99	$128.44	$201.86
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.27 / $49.02 / $86.89	Professional	26	$35.27	$49.02	$86.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $85.34 / $90.79 / $90.79	Professional	TC	$85.34	$90.79	$90.79
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.44 / $116.30 / $178.41	Professional		$38.44	$116.30	$178.41
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $145.12 / $217.68 / $302.45	Professional		$145.12	$217.68	$302.45
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.11 / $47.60 / $92.47	Professional	26	$44.11	$47.60	$92.47
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Cigna Facility/Professional Professional Modifier Low / Median / High Price $135.82 / $223.75 / $413.75	Professional		$135.82	$223.75	$413.75
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $36.67 / $59.17 / $103.97	Professional	26	$36.67	$59.17	$103.97
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $231.34 / $231.34 / $253.87	Professional	50	$231.34	$231.34	$253.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $96.47 / $160.53 / $301.58	Professional	TC	$96.47	$160.53	$301.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $341.52 / $430.56 / $442.24	Facility	26	$341.52	$430.56	$442.24
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,378.78 / $1,420.14 / $1,420.14	Professional		$1,378.78	$1,420.14	$1,420.14
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $300.10 / $300.10 / $376.28	Professional	26	$300.10	$300.10	$376.28
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,103.98 / $1,137.09 / $1,137.09	Professional	TC	$1,103.98	$1,137.09	$1,137.09
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $79.78 / $260.98 / $548.78	Professional		$79.78	$260.98	$548.78
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.73 / $181.16	Professional	26	$58.88	$74.73	$181.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $146.76 / $186.27 / $451.56	Professional	TC	$146.76	$186.27	$451.56
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.47 / $148.40 / $293.11	Professional		$53.47	$148.40	$293.11
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $54.02 / $54.02 / $54.02	Facility	26	$54.02	$54.02	$54.02
Providence Facility/Professional Professional Modifier Low / Median / High Price $141.21 / $243.99 / $456.44	Professional		$141.21	$243.99	$456.44
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.36 / $58.13 / $97.55	Professional	26	$39.36	$58.13	$97.55
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $96.47 / $156.57 / $299.43	Professional	TC	$96.47	$156.57	$299.43
United Facility/Professional Professional Modifier Low / Median / High Price $145.22 / $200.23 / $363.06	Professional		$145.22	$200.23	$363.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.26 / $51.25 / $91.53	Professional	26	$41.26	$51.25	$91.53
United Facility/Professional Professional Modifier TC Low / Median / High Price $110.74 / $151.52 / $260.56	Professional	TC	$110.74	$151.52	$260.56
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $129.47 / $145.12 / $206.06	Professional		$129.47	$145.12	$206.06
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $44.56 / $61.51	Professional	26	$38.65	$44.56	$61.51
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $90.83 / $106.15 / $1,100.00	Professional	TC	$90.83	$106.15	$1,100.00