Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.83 / $82.03 / $98.28	Facility	26	$52.83	$82.03	$98.28
Aetna Facility/Professional Professional Modifier Low / Median / High Price $250.00 / $425.00 / $808.10	Professional		$250.00	$425.00	$808.10
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.13 / $98.28 / $192.81	Professional	26	$60.13	$98.28	$192.81
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $190.20 / $328.23 / $507.50	Professional	TC	$190.20	$328.23	$507.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $197.66 / $239.08 / $449.68	Professional		$197.66	$239.08	$449.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $60.76 / $118.49	Professional	26	$48.61	$60.76	$118.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $177.28 / $177.28 / $177.28	Professional	TC	$177.28	$177.28	$177.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.72 / $217.56 / $332.77	Professional		$52.72	$217.56	$332.77
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $233.00 / $296.00 / $536.69	Professional		$233.00	$296.00	$536.69
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $60.15 / $60.15 / $64.79	Professional	26	$60.15	$60.15	$64.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $254.34 / $435.73 / $790.27	Professional		$254.34	$435.73	$790.27
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.02 / $76.04 / $138.75	Professional	26	$50.02	$76.04	$138.75
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $200.52 / $349.87 / $667.25	Professional	TC	$200.52	$349.87	$667.25
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $466.08 / $586.88 / $603.28	Facility	26	$466.08	$586.88	$603.28
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,819.97 / $2,873.43 / $2,873.43	Professional		$2,819.97	$2,873.43	$2,873.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $469.00 / $469.00 / $514.35	Professional	26	$469.00	$469.00	$514.35
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,495.53 / $2,524.69 / $2,563.91	Professional	TC	$2,495.53	$2,524.69	$2,563.91
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $282.37 / $480.35 / $1,185.16	Professional		$282.37	$480.35	$1,185.16
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $80.31 / $101.94 / $247.12	Professional	26	$80.31	$101.94	$247.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $304.86 / $386.94 / $938.04	Professional	TC	$304.86	$386.94	$938.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $69.06 / $272.14 / $551.64	Professional		$69.06	$272.14	$551.64
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $73.64 / $73.64 / $73.64	Facility	26	$73.64	$73.64	$73.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $267.47 / $464.07 / $867.05	Professional		$267.47	$464.07	$867.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.75 / $76.34 / $138.75	Professional	26	$53.75	$76.34	$138.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $207.18 / $335.90 / $658.52	Professional	TC	$207.18	$335.90	$658.52
United Facility/Professional Professional Modifier Low / Median / High Price $304.60 / $421.07 / $770.32	Professional		$304.60	$421.07	$770.32
United Facility/Professional Professional Modifier 26 Low / Median / High Price $54.76 / $69.29 / $131.29	Professional	26	$54.76	$69.29	$131.29
United Facility/Professional Professional Modifier TC Low / Median / High Price $240.87 / $346.89 / $644.14	Professional	TC	$240.87	$346.89	$644.14
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $252.87 / $282.37 / $402.52	Professional		$252.87	$282.37	$402.52
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.73 / $60.76 / $83.89	Professional	26	$52.73	$60.76	$83.89
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $200.15 / $233.95 / $1,400.00	Professional	TC	$200.15	$233.95	$1,400.00