Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $73.63 / $89.93 / $118.51	Facility	26	$73.63	$89.93	$118.51
Aetna Facility/Professional Professional Modifier Low / Median / High Price $228.67 / $312.20 / $535.55	Professional		$228.67	$312.20	$535.55
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.63 / $91.93 / $190.10	Professional	26	$73.63	$91.93	$190.10
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.19 / $212.80 / $403.94	Professional	TC	$151.19	$212.80	$403.94
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $186.98 / $257.14 / $351.59	Professional		$186.98	$257.14	$351.59
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $67.72 / $119.19 / $203.17	Professional	26	$67.72	$119.19	$203.17
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $387.36 / $387.36 / $387.36	Professional	50	$387.36	$387.36	$387.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.43 / $203.08 / $322.52	Professional		$74.43	$203.08	$322.52
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $278.04 / $379.14 / $607.62	Professional		$278.04	$379.14	$607.62
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $83.79 / $83.79 / $89.79	Professional	26	$83.79	$83.79	$89.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Cigna Facility/Professional Professional Modifier Low / Median / High Price $271.26 / $426.24 / $784.30	Professional		$271.26	$426.24	$784.30
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $67.70 / $101.34 / $184.63	Professional	26	$67.70	$101.34	$184.63
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $458.57 / $458.57 / $461.85	Professional	50	$458.57	$458.57	$461.85
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $198.17 / $326.95 / $613.90	Professional	TC	$198.17	$326.95	$613.90
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $649.67 / $816.32 / $833.76	Facility	26	$649.67	$816.32	$833.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,878.66 / $2,965.02 / $2,965.02	Professional		$2,878.66	$2,965.02	$2,965.02
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $561.99 / $561.99 / $717.75	Professional	26	$561.99	$561.99	$717.75
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,400.63 / $2,472.65 / $2,472.65	Professional	TC	$2,400.63	$2,472.65	$2,472.65
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $252.76 / $476.96 / $785.85	Professional		$252.76	$476.96	$785.85
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $111.85 / $141.97 / $344.16	Professional	26	$111.85	$141.97	$344.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $301.50 / $382.67 / $927.68	Professional	TC	$301.50	$382.67	$927.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $95.42 / $278.89 / $543.02	Professional		$95.42	$278.89	$543.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $101.96 / $101.96 / $101.96	Facility	26	$101.96	$101.96	$101.96
Providence Facility/Professional Professional Modifier Low / Median / High Price $275.43 / $475.48 / $909.28	Professional		$275.43	$475.48	$909.28
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $73.81 / $96.65 / $183.51	Professional	26	$73.81	$96.65	$183.51
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $198.17 / $326.39 / $614.26	Professional	TC	$198.17	$326.39	$614.26
United Facility/Professional Professional Modifier Low / Median / High Price $306.64 / $403.76 / $713.01	Professional		$306.64	$403.76	$713.01
United Facility/Professional Professional Modifier 26 Low / Median / High Price $76.80 / $96.00 / $170.11	Professional	26	$76.80	$96.00	$170.11
United Facility/Professional Professional Modifier TC Low / Median / High Price $225.17 / $314.81 / $529.79	Professional	TC	$225.17	$314.81	$529.79
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $225.27 / $252.76 / $358.41	Professional		$225.27	$252.76	$358.41
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $73.43 / $84.65 / $116.73	Professional	26	$73.43	$84.65	$116.73
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $151.84 / $177.46 / $1,100.00	Professional	TC	$151.84	$177.46	$1,100.00