Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $41.63 / $50.25 / $83.26	Facility	26	$41.63	$50.25	$83.26
Aetna Facility/Professional Professional Modifier Low / Median / High Price $216.91 / $279.81 / $656.51	Professional		$216.91	$279.81	$656.51
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.29 / $84.15 / $361.65	Professional	26	$47.29	$84.15	$361.65
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $162.34 / $199.51 / $348.54	Professional	TC	$162.34	$199.51	$348.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $192.60 / $231.12 / $312.98	Professional		$192.60	$231.12	$312.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.02 / $51.55 / $100.53	Professional	26	$40.02	$51.55	$100.53
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $132.44 / $160.82 / $338.28	Professional	TC	$132.44	$160.82	$338.28
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.58 / $189.29 / $362.85	Professional		$47.58	$189.29	$362.85
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $215.93 / $304.85 / $469.46	Professional		$215.93	$304.85	$469.46
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.03 / $77.06 / $77.06	Professional	26	$51.03	$77.06	$77.06
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Cigna Facility/Professional Professional Modifier Low / Median / High Price $255.37 / $376.19 / $666.36	Professional		$255.37	$376.19	$666.36
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.13 / $85.20 / $160.10	Professional	26	$54.13	$85.20	$160.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $203.84 / $296.19 / $508.56	Professional	TC	$203.84	$296.19	$508.56
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $171.00 / $377.88 / $377.88	Facility	26	$171.00	$377.88	$377.88
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,195.03 / $2,362.07 / $2,426.79	Professional		$2,195.03	$2,362.07	$2,426.79
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $480.20 / $507.12 / $521.02	Professional	26	$480.20	$507.12	$521.02
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,755.75 / $1,854.93 / $1,905.76	Professional	TC	$1,755.75	$1,854.93	$1,905.76
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $83.75 / $341.05 / $609.14	Professional		$83.75	$341.05	$609.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $61.47 / $83.84 / $124.10	Professional	26	$61.47	$83.84	$124.10
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $250.28 / $300.33 / $485.03	Professional	TC	$250.28	$300.33	$485.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.34 / $241.75 / $430.81	Professional		$60.34	$241.75	$430.81
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $62.58 / $62.58 / $62.58	Facility	26	$62.58	$62.58	$62.58
Providence Facility/Professional Professional Modifier Low / Median / High Price $256.74 / $388.85 / $695.04	Professional		$256.74	$388.85	$695.04
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $54.13 / $83.41 / $157.80	Professional	26	$54.13	$83.41	$157.80
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $205.46 / $294.14 / $484.45	Professional	TC	$205.46	$294.14	$484.45
United Facility/Professional Professional Modifier Low / Median / High Price $229.65 / $339.10 / $565.16	Professional		$229.65	$339.10	$565.16
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.27 / $73.73 / $134.99	Professional	26	$47.27	$73.73	$134.99
United Facility/Professional Professional Modifier TC Low / Median / High Price $183.03 / $263.11 / $447.50	Professional	TC	$183.03	$263.11	$447.50
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $215.61 / $240.75 / $342.95	Professional		$215.61	$240.75	$342.95
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $44.72 / $51.55 / $72.17	Professional	26	$44.72	$51.55	$72.17
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $170.88 / $189.20 / $271.97	Professional	TC	$170.88	$189.20	$271.97