Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.25 / $56.42 / $72.62	Facility	26	$45.25	$56.42	$72.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $177.77 / $236.29 / $434.90	Professional		$177.77	$236.29	$434.90
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.01 / $56.43 / $122.07	Professional	26	$47.01	$56.43	$122.07
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $132.52 / $174.29 / $297.89	Professional	TC	$132.52	$174.29	$297.89
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $198.59 / $238.31 / $261.35	Professional		$198.59	$238.31	$261.35
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.72 / $85.59 / $106.33	Professional	26	$40.72	$85.59	$106.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $108.81 / $108.81 / $108.81	Professional	TC	$108.81	$108.81	$108.81
BCBS Facility/Professional Professional Modifier Low / Median / High Price $50.32 / $146.58 / $249.44	Professional		$50.32	$146.58	$249.44
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $196.54 / $281.83 / $375.78	Professional		$196.54	$281.83	$375.78
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 $168.80 / $272.43 / $479.28	Professional		$168.80	$272.43	$479.28
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.69 / $65.55 / $114.17	Professional	26	$42.69	$65.55	$114.17
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $122.94 / $203.00 / $376.43	Professional	TC	$122.94	$203.00	$376.43
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 $1,627.19 / $1,657.60 / $1,699.73	Professional		$1,627.19	$1,657.60	$1,699.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $345.18 / $345.18 / $438.60	Professional	26	$345.18	$345.18	$438.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,330.47 / $1,357.90 / $1,366.92	Professional	TC	$1,330.47	$1,357.90	$1,366.92
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $164.10 / $295.01 / $478.94	Professional		$164.10	$295.01	$478.94
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 $187.12 / $237.50 / $575.76	Professional	TC	$187.12	$237.50	$575.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.58 / $193.93 / $363.51	Professional		$61.58	$193.93	$363.51
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 $175.92 / $295.27 / $565.16	Professional		$175.92	$295.27	$565.16
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 $123.07 / $195.01 / $373.75	Professional	TC	$123.07	$195.01	$373.75
United Facility/Professional Professional Modifier Low / Median / High Price $188.14 / $259.81 / $443.72	Professional		$188.14	$259.81	$443.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.03 / $59.19 / $104.88	Professional	26	$47.03	$59.19	$104.88
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.72 / $193.55 / $333.49	Professional	TC	$141.72	$193.55	$333.49
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $167.85 / $187.89 / $267.17	Professional		$167.85	$187.89	$267.17
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 $122.85 / $143.59 / $1,100.00	Professional	TC	$122.85	$143.59	$1,100.00