Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $23.09 / $30.02 / $101.18	Facility	26	$23.09	$30.02	$101.18
Aetna Facility/Professional Professional Modifier Low / Median / High Price $95.34 / $133.90 / $403.22	Professional		$95.34	$133.90	$403.22
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $26.23 / $35.26 / $86.16	Professional	26	$26.23	$35.26	$86.16
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $40.02 / $212.90 / $726.00	Professional	52	$40.02	$212.90	$726.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $68.13 / $92.01 / $182.26	Professional	TC	$68.13	$92.01	$182.26
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.22 / $100.67 / $186.80	Professional		$95.22	$100.67	$186.80
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $26.90 / $36.76 / $66.98	Professional	26	$26.90	$36.76	$66.98
Ambetter Facility/Professional Professional Modifier 52 Low / Median / High Price $23.80 / $24.89 / $49.10	Professional	52	$23.80	$24.89	$49.10
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $59.27 / $67.73 / $84.67	Professional	TC	$59.27	$67.73	$84.67
BCBS Facility/Professional Professional Modifier Low / Median / High Price $29.66 / $93.86 / $134.44	Professional		$29.66	$93.86	$134.44
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $112.01 / $161.79 / $215.30	Professional		$112.01	$161.79	$215.30
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $34.01 / $35.89 / $38.24	Professional	26	$34.01	$35.89	$38.24
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Cigna Facility/Professional Professional Modifier Low / Median / High Price $99.93 / $144.19 / $257.02	Professional		$99.93	$144.19	$257.02
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.20 / $40.58 / $73.68	Professional	26	$29.20	$40.58	$73.68
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $73.84 / $105.35 / $189.42	Professional	TC	$73.84	$105.35	$189.42
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $85.37 / $177.27 / $177.27	Facility	26	$85.37	$177.27	$177.27
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $825.92 / $825.92 / $1,076.40	Professional		$825.92	$825.92	$1,076.40
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $227.63 / $227.63 / $291.60	Professional	26	$227.63	$227.63	$291.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $598.35 / $598.35 / $784.73	Professional	TC	$598.35	$598.35	$784.73
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $52.50 / $162.50 / $399.70	Professional		$52.50	$162.50	$399.70
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $45.41 / $57.63 / $139.72	Professional	26	$45.41	$57.63	$139.72
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $59.20 / $130.00 / $377.28	Professional	52	$59.20	$130.00	$377.28
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $116.48 / $147.84 / $358.40	Professional	TC	$116.48	$147.84	$358.40
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $40.32 / $111.94 / $210.62	Professional		$40.32	$111.94	$210.62
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $41.28 / $41.28 / $41.28	Facility	26	$41.28	$41.28	$41.28
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.74 / $158.94 / $336.41	Professional		$102.74	$158.94	$336.41
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.52 / $39.25 / $72.19	Professional	26	$29.52	$39.25	$72.19
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $74.25 / $102.77 / $183.48	Professional	TC	$74.25	$102.77	$183.48
United Facility/Professional Professional Modifier Low / Median / High Price $111.45 / $151.71 / $225.68	Professional		$111.45	$151.71	$225.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.47 / $42.74 / $63.22	Professional	26	$31.47	$42.74	$63.22
United Facility/Professional Professional Modifier TC Low / Median / High Price $79.98 / $109.97 / $162.96	Professional	TC	$79.98	$109.97	$162.96
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $106.28 / $119.02 / $169.14	Professional		$106.28	$119.02	$169.14
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $29.81 / $34.35 / $47.40	Professional	26	$29.81	$34.35	$47.40
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $76.47 / $84.67 / $121.74	Professional	TC	$76.47	$84.67	$121.74