Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $68.25 / $83.34 / $110.58	Facility	26	$68.25	$83.34	$110.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.86 / $211.10 / $403.19	Professional		$165.86	$211.10	$403.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $68.25 / $87.48 / $255.23	Professional	26	$68.25	$87.48	$255.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $91.05 / $120.64 / $240.00	Professional	TC	$91.05	$120.64	$240.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $121.75 / $147.84 / $219.95	Professional		$121.75	$147.84	$219.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $62.02 / $85.76 / $152.02	Professional	26	$62.02	$85.76	$152.02
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $57.23 / $81.70 / $107.30	Professional	TC	$57.23	$81.70	$107.30
BCBS Facility/Professional Professional Modifier Low / Median / High Price $67.83 / $154.04 / $242.97	Professional		$67.83	$154.04	$242.97
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $172.80 / $247.44 / $339.16	Professional		$172.80	$247.44	$339.16
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $77.17 / $81.68 / $124.20	Professional	26	$77.17	$81.68	$124.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.13 / $231.28 / $418.60	Professional		$154.13	$231.28	$418.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.43 / $93.56 / $170.05	Professional	26	$62.43	$93.56	$170.05
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $85.88 / $133.11 / $255.31	Professional	TC	$85.88	$133.11	$255.31
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $598.00 / $752.64 / $770.72	Facility	26	$598.00	$752.64	$770.72
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $373.95 / $1,217.23 / $1,550.48	Professional		$373.95	$1,217.23	$1,550.48
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $521.24 / $521.24 / $659.93	Professional	26	$521.24	$521.24	$659.93
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,308.00 / $1,308.00 / $1,308.00	Professional	TC	$1,308.00	$1,308.00	$1,308.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $117.48 / $268.81 / $723.28	Professional		$117.48	$268.81	$723.28
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $103.03 / $130.76 / $317.00	Professional	26	$103.03	$130.76	$317.00
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $132.04 / $167.59 / $406.28	Professional	TC	$132.04	$167.59	$406.28
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $82.06 / $143.96 / $305.69	Professional		$82.06	$143.96	$305.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $94.15 / $94.15 / $94.15	Facility	26	$94.15	$94.15	$94.15
Providence Facility/Professional Professional Modifier Low / Median / High Price $160.19 / $254.10 / $505.52	Professional		$160.19	$254.10	$505.52
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $66.26 / $89.27 / $166.69	Professional	26	$66.26	$89.27	$166.69
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $86.82 / $129.01 / $243.39	Professional	TC	$86.82	$129.01	$243.39
United Facility/Professional Professional Modifier Low / Median / High Price $169.76 / $205.17 / $362.88	Professional		$169.76	$205.17	$362.88
United Facility/Professional Professional Modifier 26 Low / Median / High Price $71.31 / $89.14 / $156.00	Professional	26	$71.31	$89.14	$156.00
United Facility/Professional Professional Modifier TC Low / Median / High Price $96.93 / $124.96 / $209.41	Professional	TC	$96.93	$124.96	$209.41
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $154.32 / $173.93 / $245.55	Professional		$154.32	$173.93	$245.55
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $67.64 / $77.95 / $107.58	Professional	26	$67.64	$77.95	$107.58
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $86.69 / $101.30 / $1,100.00	Professional	TC	$86.69	$101.30	$1,100.00