Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.61 / $88.96 / $101.55	Facility	26	$56.61	$88.96	$101.55
Aetna Facility/Professional Professional Modifier Low / Median / High Price $190.06 / $325.45 / $638.00	Professional		$190.06	$325.45	$638.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $62.50 / $105.38 / $263.89	Professional	26	$62.50	$105.38	$263.89
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.59 / $205.66 / $433.05	Professional	TC	$125.59	$205.66	$433.05
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $129.11 / $155.79 / $304.33	Professional		$129.11	$155.79	$304.33
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.19 / $80.27 / $127.21	Professional	26	$52.19	$80.27	$127.21
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $95.36 / $95.36 / $95.36	Professional	TC	$95.36	$95.36	$95.36
BCBS Facility/Professional Professional Modifier Low / Median / High Price $56.84 / $156.00 / $240.96	Professional		$56.84	$156.00	$240.96
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $192.41 / $295.10 / $381.00	Professional		$192.41	$295.10	$381.00
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $64.56 / $64.56 / $69.48	Professional	26	$64.56	$64.56	$69.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Cigna Facility/Professional Professional Modifier Low / Median / High Price $165.63 / $370.01 / $723.64	Professional		$165.63	$370.01	$723.64
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $53.98 / $83.34 / $149.57	Professional	26	$53.98	$83.34	$149.57
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.86 / $262.50 / $574.09	Professional	TC	$107.86	$262.50	$574.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $500.48 / $629.60 / $647.12	Facility	26	$500.48	$629.60	$647.12
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,831.41 / $2,916.35 / $2,916.35	Professional		$2,831.41	$2,916.35	$2,916.35
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $579.54 / $579.54 / $579.54	Professional	26	$579.54	$579.54	$579.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,465.48 / $2,539.44 / $2,539.44	Professional	TC	$2,465.48	$2,539.44	$2,539.44
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $107.06 / $288.69 / $755.00	Professional		$107.06	$288.69	$755.00
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $86.20 / $109.41 / $265.24	Professional	26	$86.20	$109.41	$265.24
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $164.00 / $208.15 / $504.60	Professional	TC	$164.00	$208.15	$504.60
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $73.34 / $152.34 / $353.50	Professional		$73.34	$152.34	$353.50
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $79.09 / $79.09 / $79.09	Facility	26	$79.09	$79.09	$79.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $184.44 / $375.00 / $695.00	Professional		$184.44	$375.00	$695.00
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $57.76 / $83.23 / $149.57	Professional	26	$57.76	$83.23	$149.57
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.95 / $262.50 / $565.29	Professional	TC	$112.95	$262.50	$565.29
United Facility/Professional Professional Modifier Low / Median / High Price $195.03 / $335.49 / $616.62	Professional		$195.03	$335.49	$616.62
United Facility/Professional Professional Modifier 26 Low / Median / High Price $59.59 / $75.06 / $142.24	Professional	26	$59.59	$75.06	$142.24
United Facility/Professional Professional Modifier TC Low / Median / High Price $130.68 / $239.33 / $425.70	Professional	TC	$130.68	$239.33	$425.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $164.26 / $184.44 / $261.39	Professional		$164.26	$184.44	$261.39
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.59 / $65.23 / $90.00	Professional	26	$56.59	$65.23	$90.00
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $107.67 / $125.84 / $1,400.00	Professional	TC	$107.67	$125.84	$1,400.00