Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $61.66 / $77.62	Facility	26	$50.12	$61.66	$77.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $239.88 / $562.34	Professional		$165.96	$239.88	$562.34
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $190.55	Professional	26	$52.48	$77.62	$190.55
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $151.36 / $331.13	Professional	TC	$107.15	$151.36	$331.13
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $131.83 / $173.78	Professional		$87.10	$131.83	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $57.54 / $112.20	Professional	26	$44.67	$57.54	$112.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $107.15 / $147.91	Professional	TC	$83.18	$107.15	$147.91
BCBS Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $138.04 / $186.21	Professional		$48.98	$138.04	$186.21
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $204.17 / $269.15	Professional		$154.88	$204.17	$269.15
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $128.82 / $128.82	Professional	26	$56.23	$128.82	$128.82
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $257.04 / $524.81	Professional		$154.88	$257.04	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $141.25	Professional	26	$50.12	$75.86	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $177.83 / $371.54	Professional	TC	$104.71	$177.83	$371.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.54 / $549.54 / $549.54	Facility	26	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $478.63 / $478.63	Professional	26	$436.52	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Professional	TC	$1,621.81	$1,621.81	$1,621.81
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $60.26 / $81.28	Facility	26	$50.12	$60.26	$81.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $588.84	Professional		$169.82	$281.84	$588.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $79.43 / $173.78	Professional	26	$53.70	$79.43	$173.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $173.78 / $363.08	Professional	TC	$112.20	$173.78	$363.08
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $141.25	Professional		$32.36	$33.11	$141.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $165.96 / $389.05	Professional		$60.26	$165.96	$389.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $263.03 / $489.78	Professional		$158.49	$263.03	$489.78
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $120.23	Professional	26	$50.12	$70.79	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $177.83 / $354.81	Professional	TC	$102.33	$177.83	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $234.42 / $426.58	Professional		$165.96	$234.42	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $64.57 / $114.82	Professional	26	$51.29	$64.57	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $154.88 / $295.12	Professional	TC	$109.65	$154.88	$295.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $173.78 / $208.93	Professional		$165.96	$173.78	$208.93
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $58.88 / $70.79	Professional	26	$57.54	$58.88	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $134.90	Professional	TC	$109.65	$109.65	$134.90