Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.09 / $62.64 / $79.73	Facility	26	$50.09	$62.64	$79.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.65 / $275.00 / $875.00	Professional		$199.65	$275.00	$875.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $63.66 / $136.46	Professional	26	$51.30	$63.66	$136.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $149.56 / $209.38 / $393.13	Professional	TC	$149.56	$209.38	$393.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.77 / $183.40 / $275.11	Professional		$151.77	$183.40	$275.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $45.56 / $62.65 / $111.06	Professional	26	$45.56	$62.65	$111.06
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $223.80 / $223.80 / $223.80	Professional	TC	$223.80	$223.80	$223.80
BCBS Facility/Professional Professional Modifier Low / Median / High Price $49.52 / $185.68 / $287.47	Professional		$49.52	$185.68	$287.47
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $205.97 / $227.00 / $385.92	Professional		$205.97	$227.00	$385.92
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.38 / $59.86 / $152.77	Professional	26	$56.38	$59.86	$152.77
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Cigna Facility/Professional Professional Modifier Low / Median / High Price $193.93 / $299.79 / $539.32	Professional		$193.93	$299.79	$539.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.87 / $70.50 / $124.96	Professional	26	$46.87	$70.50	$124.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.11 / $222.34 / $419.56	Professional	TC	$144.11	$222.34	$419.56
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $436.88 / $549.76 / $565.04	Facility	26	$436.88	$549.76	$565.04
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,846.75 / $1,902.16 / $1,964.18	Professional		$1,846.75	$1,902.16	$1,964.18
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $444.14 / $444.14 / $482.33	Professional	26	$444.14	$444.14	$482.33
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,104.00 / $2,104.00 / $2,104.00	Professional	TC	$2,104.00	$2,104.00	$2,104.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $106.08 / $340.61 / $564.98	Professional		$106.08	$340.61	$564.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $75.27 / $95.54 / $231.60	Professional	26	$75.27	$95.54	$231.60
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $219.92 / $279.13 / $676.68	Professional	TC	$219.92	$279.13	$676.68
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $63.95 / $194.56 / $388.02	Professional		$63.95	$194.56	$388.02
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $69.05 / $69.05 / $69.05	Facility	26	$69.05	$69.05	$69.05
Providence Facility/Professional Professional Modifier Low / Median / High Price $200.96 / $333.06 / $648.41	Professional		$200.96	$333.06	$648.41
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.42 / $70.50 / $121.50	Professional	26	$50.42	$70.50	$121.50
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.44 / $217.87 / $411.10	Professional	TC	$144.44	$217.87	$411.10
United Facility/Professional Professional Modifier Low / Median / High Price $206.14 / $286.67 / $498.06	Professional		$206.14	$286.67	$498.06
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.18 / $65.31 / $116.66	Professional	26	$52.18	$65.31	$116.66
United Facility/Professional Professional Modifier TC Low / Median / High Price $150.49 / $216.41 / $381.90	Professional	TC	$150.49	$216.41	$381.90
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $193.80 / $216.81 / $308.45	Professional		$193.80	$216.81	$308.45
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $49.42 / $56.95 / $78.59	Professional	26	$49.42	$56.95	$78.59
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $144.38 / $168.77 / $1,100.00	Professional	TC	$144.38	$168.77	$1,100.00