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 / $65.67	Facility	26	$39.29	$49.09	$65.67
Aetna Facility/Professional Professional Modifier Low / Median / High Price $113.01 / $167.73 / $379.63	Professional		$113.01	$167.73	$379.63
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.77 / $51.30 / $111.23	Professional	26	$41.77	$51.30	$111.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.50 / $110.84 / $231.46	Professional	TC	$75.50	$110.84	$231.46
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $98.00 / $103.33 / $196.97	Professional		$98.00	$103.33	$196.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.27 / $46.72 / $86.89	Professional	26	$35.27	$46.72	$86.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $62.35 / $62.35 / $62.35	Professional	TC	$62.35	$62.35	$62.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.44 / $108.75 / $168.47	Professional		$38.44	$108.75	$168.47
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $122.50 / $196.00 / $266.00	Professional		$122.50	$196.00	$266.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.11 / $47.60 / $49.98	Professional	26	$44.11	$47.60	$49.98
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 $109.79 / $210.00 / $396.46	Professional		$109.79	$210.00	$396.46
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 $231.80 / $231.80 / $253.87	Professional	50	$231.80	$231.80	$253.87
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.43 / $147.00 / $289.67	Professional	TC	$70.43	$147.00	$289.67
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 $1,332.00 / $1,332.00 / $1,332.00	Professional	TC	$1,332.00	$1,332.00	$1,332.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $72.83 / $184.72 / $458.25	Professional		$72.83	$184.72	$458.25
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $74.73 / $191.66	Professional	26	$58.88	$74.73	$191.66
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $107.22 / $136.09 / $329.92	Professional	TC	$107.22	$136.09	$329.92
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.93 / $102.86 / $223.62	Professional		$50.93	$102.86	$223.62
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 $120.29 / $228.50 / $400.00	Professional		$120.29	$228.50	$400.00
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 $71.65 / $147.00 / $294.54	Professional	TC	$71.65	$147.00	$294.54
United Facility/Professional Professional Modifier Low / Median / High Price $133.75 / $193.08 / $350.80	Professional		$133.75	$193.08	$350.80
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.00 / $51.25 / $97.38	Professional	26	$41.00	$51.25	$97.38
United Facility/Professional Professional Modifier TC Low / Median / High Price $90.19 / $137.34 / $237.89	Professional	TC	$90.19	$137.34	$237.89
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $109.05 / $122.50 / $173.58	Professional		$109.05	$122.50	$173.58
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 $70.39 / $82.29 / $1,100.00	Professional	TC	$70.39	$82.29	$1,100.00