Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $25.51 / $33.11 / $52.87	Facility	26	$25.51	$33.11	$52.87
Aetna Facility/Professional Professional Modifier Low / Median / High Price $183.82 / $235.81 / $622.05	Professional		$183.82	$235.81	$622.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $25.51 / $36.75 / $124.46	Professional	26	$25.51	$36.75	$124.46
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $158.31 / $202.69 / $388.90	Professional	TC	$158.31	$202.69	$388.90
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $194.88 / $194.88 / $401.89	Professional		$194.88	$194.88	$401.89
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $32.21 / $53.24 / $73.89	Professional	26	$32.21	$53.24	$73.89
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $143.99 / $175.10 / $230.00	Professional	TC	$143.99	$175.10	$230.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $32.46 / $225.06 / $285.80	Professional		$32.46	$225.06	$285.80
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $155.00 / $184.00 / $304.50	Professional		$155.00	$184.00	$304.50
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $37.50 / $189.59 / $189.59	Professional	26	$37.50	$189.59	$189.59
Cigna Facility/Professional Professional Modifier Low / Median / High Price $201.72 / $296.17 / $500.50	Professional		$201.72	$296.17	$500.50
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.52 / $49.38 / $81.51	Professional	26	$33.52	$49.38	$81.51
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $169.12 / $247.57 / $428.58	Professional	TC	$169.12	$247.57	$428.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $203.00 / $225.00	Facility	26	$100.00	$203.00	$225.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,813.42 / $1,813.42 / $2,228.78	Professional		$1,813.42	$1,813.42	$2,228.78
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $328.57 / $328.57 / $328.57	Professional	26	$328.57	$328.57	$328.57
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,562.23 / $1,562.23 / $1,908.45	Professional	TC	$1,562.23	$1,562.23	$1,908.45
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $69.69 / $422.70 / $789.23	Professional		$69.69	$422.70	$789.23
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.96 / $68.70 / $153.96	Professional	26	$54.96	$68.70	$153.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $310.86 / $388.58 / $870.76	Professional	TC	$310.86	$388.58	$870.76
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $47.03 / $274.23 / $514.79	Professional		$47.03	$274.23	$514.79
Providence Facility/Professional Professional Modifier Low / Median / High Price $209.75 / $300.14 / $525.36	Professional		$209.75	$300.14	$525.36
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.97 / $52.39 / $81.89	Professional	26	$33.97	$52.39	$81.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $179.52 / $258.51 / $429.98	Professional	TC	$179.52	$258.51	$429.98
United Facility/Professional Professional Modifier Low / Median / High Price $204.21 / $264.43 / $440.50	Professional		$204.21	$264.43	$440.50
United Facility/Professional Professional Modifier 26 Low / Median / High Price $34.94 / $42.80 / $65.51	Professional	26	$34.94	$42.80	$65.51
United Facility/Professional Professional Modifier TC Low / Median / High Price $168.78 / $222.79 / $378.66	Professional	TC	$168.78	$222.79	$378.66
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $218.64 / $243.60 / $347.96	Professional		$218.64	$243.60	$347.96
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $32.85 / $37.89 / $52.25	Professional	26	$32.85	$37.89	$52.25
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $185.79 / $205.70 / $295.72	Professional	TC	$185.79	$205.70	$295.72