Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.82 / $58.42 / $75.77	Facility	26	$47.82	$58.42	$75.77
Aetna Facility/Professional Professional Modifier Low / Median / High Price $175.46 / $245.24 / $447.23	Professional		$175.46	$245.24	$447.23
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.33 / $59.84 / $88.36	Professional	26	$50.33	$59.84	$88.36
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.14 / $174.40 / $388.52	Professional	TC	$125.14	$174.40	$388.52
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $135.85 / $147.34 / $194.07	Professional		$135.85	$147.34	$194.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.29 / $88.14 / $105.53	Professional	26	$43.29	$88.14	$105.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $103.68 / $103.68 / $103.68	Professional	TC	$103.68	$103.68	$103.68
BCBS Facility/Professional Professional Modifier Low / Median / High Price $51.57 / $149.83 / $244.35	Professional		$51.57	$149.83	$244.35
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $183.72 / $211.28 / $348.03	Professional		$183.72	$211.28	$348.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $53.56 / $57.16 / $184.94	Professional	26	$53.56	$57.16	$184.94
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Cigna Facility/Professional Professional Modifier Low / Median / High Price $164.96 / $311.60 / $603.95	Professional		$164.96	$311.60	$603.95
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.10 / $65.91 / $119.44	Professional	26	$44.10	$65.91	$119.44
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $117.15 / $236.42 / $489.00	Professional	TC	$117.15	$236.42	$489.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $414.72 / $522.72 / $537.20	Facility	26	$414.72	$522.72	$537.20
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,019.70 / $2,082.64 / $2,082.64	Professional		$2,019.70	$2,082.64	$2,082.64
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $381.41 / $381.41 / $456.90	Professional	26	$381.41	$381.41	$456.90
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,705.05 / $1,754.89 / $1,802.98	Professional	TC	$1,705.05	$1,754.89	$1,802.98
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $240.18 / $317.02 / $462.95	Professional		$240.18	$317.02	$462.95
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $71.48 / $90.73 / $219.96	Professional	26	$71.48	$90.73	$219.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $178.30 / $226.30 / $548.60	Professional	TC	$178.30	$226.30	$548.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $61.33 / $165.88 / $331.33	Professional		$61.33	$165.88	$331.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $65.64 / $65.64 / $65.64	Facility	26	$65.64	$65.64	$65.64
Providence Facility/Professional Professional Modifier Low / Median / High Price $172.13 / $349.32 / $606.48	Professional		$172.13	$349.32	$606.48
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.52 / $62.00 / $116.75	Professional	26	$47.52	$62.00	$116.75
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $117.15 / $231.51 / $490.25	Professional	TC	$117.15	$231.51	$490.25
United Facility/Professional Professional Modifier Low / Median / High Price $201.24 / $301.86 / $531.62	Professional		$201.24	$301.86	$531.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $62.07 / $110.86	Professional	26	$49.61	$62.07	$110.86
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.47 / $227.08 / $378.29	Professional	TC	$148.47	$227.08	$378.29
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $163.99 / $183.72 / $261.02	Professional		$163.99	$183.72	$261.02
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.93 / $54.12 / $74.68	Professional	26	$46.93	$54.12	$74.68
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $117.05 / $136.81 / $1,100.00	Professional	TC	$117.05	$136.81	$1,100.00