Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.98 / $82.03 / $99.99	Facility	26	$52.98	$82.03	$99.99
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.32 / $346.43 / $725.00	Professional		$195.32	$346.43	$725.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.32 / $101.92 / $254.90	Professional	26	$60.32	$101.92	$254.90
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $475.00 / $475.00 / $475.00	Professional	50	$475.00	$475.00	$475.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.66 / $144.01 / $273.75	Professional	52	$97.66	$144.01	$273.75
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $135.00 / $235.16 / $502.50	Professional	TC	$135.00	$235.16	$502.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.11 / $168.59 / $341.62	Professional		$134.11	$168.59	$341.62
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.61 / $63.24 / $118.49	Professional	26	$48.61	$63.24	$118.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $78.00 / $104.65 / $111.40	Professional	TC	$78.00	$104.65	$111.40
BCBS Facility/Professional Professional Modifier Low / Median / High Price $52.72 / $158.25 / $245.90	Professional		$52.72	$158.25	$245.90
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $191.35 / $287.37 / $568.03	Professional		$191.35	$287.37	$568.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $60.15 / $64.23 / $115.72	Professional	26	$60.15	$64.23	$115.72
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 $171.03 / $319.73 / $758.16	Professional		$171.03	$319.73	$758.16
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.61 / $73.36 / $134.09	Professional	26	$49.61	$73.36	$134.09
Cigna Facility/Professional Professional Modifier 50 Low / Median / High Price $301.29 / $301.29 / $366.14	Professional	50	$301.29	$301.29	$366.14
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $118.35 / $229.77 / $580.47	Professional	TC	$118.35	$229.77	$580.47
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 $1,056.00 / $2,873.43 / $2,873.43	Professional		$1,056.00	$2,873.43	$2,873.43
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $525.38 / $525.38 / $525.38	Professional	26	$525.38	$525.38	$525.38
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,451.15 / $2,524.69 / $2,524.69	Professional	TC	$2,451.15	$2,524.69	$2,524.69
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $107.98 / $294.02 / $800.88	Professional		$107.98	$294.02	$800.88
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 $179.97 / $228.43 / $335.02	Professional	TC	$179.97	$228.43	$335.02
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $68.59 / $167.47 / $368.90	Professional		$68.59	$167.47	$368.90
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 $177.90 / $374.82 / $706.36	Professional		$177.90	$374.82	$706.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $53.36 / $70.20 / $129.86	Professional	26	$53.36	$70.20	$129.86
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $118.36 / $223.34 / $580.47	Professional	TC	$118.36	$223.34	$580.47
United Facility/Professional Professional Modifier Low / Median / High Price $197.56 / $280.44 / $600.01	Professional		$197.56	$280.44	$600.01
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 $138.66 / $214.77 / $427.24	Professional	TC	$138.66	$214.77	$427.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $170.88 / $191.58 / $271.92	Professional		$170.88	$191.58	$271.92
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 $118.15 / $138.07 / $1,400.00	Professional	TC	$118.15	$138.07	$1,400.00