Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.60 / $63.15 / $96.66	Facility	26	$48.60	$63.15	$96.66
Aetna Facility/Professional Professional Modifier Low / Median / High Price $157.94 / $219.29 / $522.50	Professional		$157.94	$219.29	$522.50
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.59 / $72.59 / $140.00	Professional	26	$50.59	$72.59	$140.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $105.01 / $143.86 / $335.00	Professional	TC	$105.01	$143.86	$335.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.26 / $174.00 / $366.68	Professional		$144.26	$174.00	$366.68
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.71 / $122.91 / $122.91	Professional	26	$41.71	$122.91	$122.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $74.40 / $166.95 / $276.97	Professional		$74.40	$166.95	$276.97
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $206.09 / $281.37 / $338.74	Professional		$206.09	$281.37	$338.74
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $70.87 / $74.81 / $79.79	Professional	26	$70.87	$74.81	$79.79
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Cigna Facility/Professional Professional Modifier Low / Median / High Price $182.94 / $269.02 / $494.54	Professional		$182.94	$269.02	$494.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.24 / $85.66 / $155.97	Professional	26	$57.24	$85.66	$155.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $121.51 / $181.32 / $331.86	Professional	TC	$121.51	$181.32	$331.86
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.04 / $691.52 / $707.68	Facility	26	$549.04	$691.52	$707.68
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,484.56 / $1,484.56 / $1,852.58	Professional		$1,484.56	$1,484.56	$1,852.58
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $478.82 / $478.82 / $605.54	Professional	26	$478.82	$478.82	$605.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,005.68 / $1,005.68 / $1,247.03	Professional	TC	$1,005.68	$1,005.68	$1,247.03
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $268.88 / $354.92 / $548.10	Professional		$268.88	$354.92	$548.10
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $94.61 / $120.09 / $291.12	Professional	26	$94.61	$120.09	$291.12
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $185.02 / $234.83 / $569.28	Professional	TC	$185.02	$234.83	$569.28
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $80.50 / $177.79 / $378.33	Professional		$80.50	$177.79	$378.33
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $86.45 / $86.45 / $86.45	Facility	26	$86.45	$86.45	$86.45
Providence Facility/Professional Professional Modifier Low / Median / High Price $190.95 / $300.08 / $619.07	Professional		$190.95	$300.08	$619.07
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $60.86 / $82.38 / $153.26	Professional	26	$60.86	$82.38	$153.26
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $121.56 / $176.56 / $324.36	Professional	TC	$121.56	$176.56	$324.36
United Facility/Professional Professional Modifier Low / Median / High Price $217.95 / $434.37 / $868.73	Professional		$217.95	$434.37	$868.73
United Facility/Professional Professional Modifier 26 Low / Median / High Price $65.54 / $81.92 / $147.12	Professional	26	$65.54	$81.92	$147.12
United Facility/Professional Professional Modifier TC Low / Median / High Price $148.99 / $347.18 / $763.70	Professional	TC	$148.99	$347.18	$763.70
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $183.58 / $206.09 / $292.19	Professional		$183.58	$206.09	$292.19
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $62.12 / $71.59 / $98.82	Professional	26	$62.12	$71.59	$98.82
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $121.47 / $141.97 / $1,400.00	Professional	TC	$121.47	$141.97	$1,400.00