Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.98 / $57.93 / $74.41	Facility	26	$46.98	$57.93	$74.41
Aetna Facility/Professional Professional Modifier Low / Median / High Price $122.92 / $171.98 / $597.64	Professional		$122.92	$171.98	$597.64
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.14 / $58.79 / $127.42	Professional	26	$48.14	$58.79	$127.42
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $73.48 / $102.40 / $224.97	Professional	TC	$73.48	$102.40	$224.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $90.27 / $108.68 / $179.37	Professional		$90.27	$108.68	$179.37
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.52 / $57.76 / $103.64	Professional	26	$42.52	$57.76	$103.64
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $106.12 / $106.12 / $106.12	Professional	TC	$106.12	$106.12	$106.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.13 / $113.74 / $179.61	Professional		$46.13	$113.74	$179.61
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $135.08 / $206.32 / $257.89	Professional		$135.08	$206.32	$257.89
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $52.61 / $52.61 / $56.87	Professional	26	$52.61	$52.61	$56.87
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Cigna Facility/Professional Professional Modifier Low / Median / High Price $115.47 / $207.96 / $412.00	Professional		$115.47	$207.96	$412.00
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $43.74 / $64.64 / $117.15	Professional	26	$43.74	$64.64	$117.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $68.50 / $135.33 / $286.02	Professional	TC	$68.50	$135.33	$286.02
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $407.44 / $513.44 / $527.60	Facility	26	$407.44	$513.44	$527.60
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,561.56 / $1,608.41 / $1,608.41	Professional		$1,561.56	$1,608.41	$1,608.41
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $386.35 / $386.35 / $449.18	Professional	26	$386.35	$386.35	$449.18
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,649.00 / $1,649.00 / $1,649.00	Professional	TC	$1,649.00	$1,649.00	$1,649.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $128.94 / $221.50 / $536.96	Professional		$128.94	$221.50	$536.96
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $70.23 / $89.13 / $216.08	Professional	26	$70.23	$89.13	$216.08
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $104.29 / $132.36 / $320.88	Professional	TC	$104.29	$132.36	$320.88
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $53.98 / $100.74 / $236.39	Professional		$53.98	$100.74	$236.39
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $64.44 / $64.44 / $64.44	Facility	26	$64.44	$64.44	$64.44
Providence Facility/Professional Professional Modifier Low / Median / High Price $119.55 / $220.00 / $408.95	Professional		$119.55	$220.00	$408.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.97 / $63.00 / $114.02	Professional	26	$46.97	$63.00	$114.02
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $68.55 / $137.96 / $283.94	Professional	TC	$68.55	$137.96	$283.94
United Facility/Professional Professional Modifier Low / Median / High Price $128.84 / $181.90 / $331.92	Professional		$128.84	$181.90	$331.92
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.64 / $60.99 / $108.07	Professional	26	$48.64	$60.99	$108.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.00 / $117.76 / $217.54	Professional	TC	$77.00	$117.76	$217.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $114.57 / $128.94 / $182.36	Professional		$114.57	$128.94	$182.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.10 / $53.15 / $73.36	Professional	26	$46.10	$53.15	$73.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $68.47 / $80.03 / $1,100.00	Professional	TC	$68.47	$80.03	$1,100.00