Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.12 / $38.97 / $60.80	Facility	26	$30.12	$38.97	$60.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $87.92 / $135.09 / $519.00	Professional		$87.92	$135.09	$519.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $32.88 / $45.36 / $178.04	Professional	26	$32.88	$45.36	$178.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $48.47 / $66.95 / $131.31	Professional	TC	$48.47	$66.95	$131.31
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $82.25 / $108.42 / $170.66	Professional		$82.25	$108.42	$170.66
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.95 / $44.54 / $86.86	Professional	26	$34.95	$44.54	$86.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $48.46 / $57.02 / $114.16	Professional	TC	$48.46	$57.02	$114.16
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.19 / $84.69 / $120.78	Professional		$38.19	$84.69	$120.78
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $107.27 / $151.79 / $232.34	Professional		$107.27	$151.79	$232.34
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $44.09 / $47.46 / $84.25	Professional	26	$44.09	$47.46	$84.25
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Cigna Facility/Professional Professional Modifier Low / Median / High Price $95.40 / $126.52 / $239.90	Professional		$95.40	$126.52	$239.90
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.86 / $50.19 / $93.48	Professional	26	$37.86	$50.19	$93.48
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $54.30 / $75.61 / $146.00	Professional	TC	$54.30	$75.61	$146.00
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $111.13 / $230.61 / $230.61	Facility	26	$111.13	$230.61	$230.61
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $757.96 / $757.96 / $968.93	Professional		$757.96	$757.96	$968.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $312.14 / $322.45 / $376.50	Professional	26	$312.14	$322.45	$376.50
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $470.82 / $484.95 / $592.35	Professional	TC	$470.82	$484.95	$592.35
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $82.67 / $167.47 / $263.81	Professional		$82.67	$167.47	$263.81
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.13 / $67.94 / $181.16	Professional	26	$53.13	$67.94	$181.16
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.29 / $101.40 / $270.39	Professional	TC	$79.29	$101.40	$270.39
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.52 / $79.87 / $184.96	Professional		$41.52	$79.87	$184.96
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $53.62 / $53.62 / $53.62	Facility	26	$53.62	$53.62	$53.62
Providence Facility/Professional Professional Modifier Low / Median / High Price $97.10 / $131.43 / $270.77	Professional		$97.10	$131.43	$270.77
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.50 / $48.61 / $89.85	Professional	26	$38.50	$48.61	$89.85
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $55.70 / $72.06 / $137.83	Professional	TC	$55.70	$72.06	$137.83
United Facility/Professional Professional Modifier Low / Median / High Price $99.61 / $131.21 / $195.58	Professional		$99.61	$131.21	$195.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $39.83 / $51.28 / $81.19	Professional	26	$39.83	$51.28	$81.19
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.68 / $78.58 / $119.24	Professional	TC	$61.68	$78.58	$119.24
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $96.35 / $108.42 / $153.36	Professional		$96.35	$108.42	$153.36
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.65 / $44.54 / $62.36	Professional	26	$38.65	$44.54	$62.36
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $57.69 / $63.88 / $91.85	Professional	TC	$57.69	$63.88	$91.85