Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $71.65 / $89.48 / $185.84	Facility	26	$71.65	$89.48	$185.84
Aetna Facility/Professional Professional Modifier Low / Median / High Price $271.92 / $341.58 / $657.24	Professional		$271.92	$341.58	$657.24
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $72.86 / $94.32 / $308.52	Professional	26	$72.86	$94.32	$308.52
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $200.27 / $247.05 / $445.97	Professional	TC	$200.27	$247.05	$445.97
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $227.29 / $284.11 / $554.01	Professional		$227.29	$284.11	$554.01
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $65.65 / $115.65 / $160.03	Professional	26	$65.65	$115.65	$160.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $120.52 / $171.77 / $349.54	Professional	TC	$120.52	$171.77	$349.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.84 / $251.61 / $355.00	Professional		$70.84	$251.61	$355.00
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $272.00 / $394.00 / $538.34	Professional		$272.00	$394.00	$538.34
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $81.23 / $85.97 / $237.92	Professional	26	$81.23	$85.97	$237.92
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Cigna Facility/Professional Professional Modifier Low / Median / High Price $235.00 / $352.19 / $643.90	Professional		$235.00	$352.19	$643.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.00 / $96.73 / $177.37	Professional	26	$66.00	$96.73	$177.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $164.50 / $256.63 / $474.02	Professional	TC	$164.50	$256.63	$474.02
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $630.16 / $791.44 / $805.76	Facility	26	$630.16	$791.44	$805.76
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $495.67 / $2,077.84 / $2,569.28	Professional		$495.67	$2,077.84	$2,569.28
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $547.02 / $547.02 / $697.13	Professional	26	$547.02	$547.02	$697.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,614.00 / $2,614.00 / $2,614.00	Professional	TC	$2,614.00	$2,614.00	$2,614.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $143.50 / $383.25 / $845.00	Professional		$143.50	$383.25	$845.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $108.49 / $137.69 / $333.80	Professional	26	$108.49	$137.69	$333.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $277.95 / $352.79 / $855.24	Professional	TC	$277.95	$352.79	$855.24
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $93.24 / $258.26 / $496.43	Professional		$93.24	$258.26	$496.43
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $98.40 / $98.40 / $98.40	Facility	26	$98.40	$98.40	$98.40
Providence Facility/Professional Professional Modifier Low / Median / High Price $241.49 / $384.56 / $808.92	Professional		$241.49	$384.56	$808.92
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $70.50 / $92.06 / $171.73	Professional	26	$70.50	$92.06	$171.73
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $164.50 / $247.92 / $471.11	Professional	TC	$164.50	$247.92	$471.11
United Facility/Professional Professional Modifier Low / Median / High Price $275.39 / $332.39 / $593.65	Professional		$275.39	$332.39	$593.65
United Facility/Professional Professional Modifier 26 Low / Median / High Price $74.78 / $93.47 / $166.94	Professional	26	$74.78	$93.47	$166.94
United Facility/Professional Professional Modifier TC Low / Median / High Price $191.13 / $238.92 / $406.16	Professional	TC	$191.13	$238.92	$406.16
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $253.70 / $284.11 / $403.76	Professional		$253.70	$284.11	$403.76
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $71.22 / $82.07 / $113.20	Professional	26	$71.22	$82.07	$113.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $182.48 / $213.32 / $1,100.00	Professional	TC	$182.48	$213.32	$1,100.00