Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $34.79 / $41.71 / $75.15	Facility	26	$34.79	$41.71	$75.15
Aetna Facility/Professional Professional Modifier Low / Median / High Price $206.63 / $251.20 / $389.72	Professional		$206.63	$251.20	$389.72
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.22 / $45.43 / $79.63	Professional	26	$37.22	$45.43	$79.63
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.49 / $208.65 / $335.72	Professional	TC	$162.49	$208.65	$335.72
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $165.43 / $189.07 / $189.07	Professional		$165.43	$189.07	$189.07
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $24.82 / $69.29 / $82.97	Professional	26	$24.82	$69.29	$82.97
BCBS Facility/Professional Professional Modifier Low / Median / High Price $35.86 / $191.89 / $367.85	Professional		$35.86	$191.89	$367.85
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $210.60 / $234.00 / $378.13	Professional		$210.60	$234.00	$378.13
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $42.14 / $44.74 / $44.74	Professional	26	$42.14	$44.74	$44.74
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Cigna Facility/Professional Professional Modifier Low / Median / High Price $247.68 / $357.02 / $614.32	Professional		$247.68	$357.02	$614.32
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.71 / $99.03	Professional	26	$44.67	$58.71	$99.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $209.11 / $299.24 / $537.85	Professional	TC	$209.11	$299.24	$537.85
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $104.57 / $221.73 / $221.73	Facility	26	$104.57	$221.73	$221.73
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,904.10 / $1,956.28 / $2,158.73	Professional		$1,904.10	$1,956.28	$2,158.73
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $467.26 / $588.72 / $588.72	Professional	26	$467.26	$588.72	$588.72
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,640.58 / $1,685.53 / $1,797.00	Professional	TC	$1,640.58	$1,685.53	$1,797.00
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $236.33 / $372.63 / $615.98	Professional		$236.33	$372.63	$615.98
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $50.84 / $69.34 / $102.78	Professional	26	$50.84	$69.34	$102.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $240.56 / $328.13 / $513.19	Professional	TC	$240.56	$328.13	$513.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.75 / $248.50 / $413.58	Professional		$48.75	$248.50	$413.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $52.19 / $52.19 / $52.19	Facility	26	$52.19	$52.19	$52.19
Providence Facility/Professional Professional Modifier Low / Median / High Price $250.41 / $367.03 / $679.76	Professional		$250.41	$367.03	$679.76
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.32 / $58.53 / $89.60	Professional	26	$44.32	$58.53	$89.60
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $210.31 / $295.83 / $536.96	Professional	TC	$210.31	$295.83	$536.96
United Facility/Professional Professional Modifier Low / Median / High Price $222.31 / $319.57 / $514.08	Professional		$222.31	$319.57	$514.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $38.72 / $50.83 / $82.82	Professional	26	$38.72	$50.83	$82.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $183.33 / $263.56 / $428.38	Professional	TC	$183.33	$263.56	$428.38
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $212.02 / $236.33 / $337.47	Professional		$212.02	$236.33	$337.47
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $36.99 / $42.55 / $59.57	Professional	26	$36.99	$42.55	$59.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $175.03 / $193.79 / $278.63	Professional	TC	$175.03	$193.79	$278.63