Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $40.74 / $58.88	Facility	26	$33.11	$40.74	$58.88
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $213.80 / $676.08	Professional		$120.23	$213.80	$676.08
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $57.54 / $186.21	Professional	26	$37.15	$57.54	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $125.89 / $295.12	Professional	TC	$83.18	$125.89	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $87.10 / $112.20 / $194.98	Professional		$87.10	$112.20	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $38.90 / $69.18	Professional	26	$30.90	$38.90	$69.18
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $69.18 / $128.82	Professional	TC	$58.88	$69.18	$128.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $102.33 / $138.04	Professional		$33.11	$102.33	$138.04
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $199.53 / $407.38	Professional		$123.03	$199.53	$407.38
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $85.11 / $85.11	Professional	26	$38.02	$85.11	$85.11
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $46.77 / $66.07	Facility	26	$10.00	$46.77	$66.07
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $213.80 / $416.87	Professional		$114.82	$213.80	$416.87
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $57.54 / $107.15	Professional	26	$33.88	$57.54	$107.15
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $151.36 / $295.12	Professional	TC	$77.62	$151.36	$295.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $371.54 / $371.54 / $371.54	Facility	26	$371.54	$371.54	$371.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $1,380.38 / $1,412.54	Professional		$158.49	$1,380.38	$1,412.54
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $331.13 / $331.13	Professional	26	$331.13	$331.13	$331.13
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,230.27 / $1,230.27 / $1,230.27	Professional	TC	$1,230.27	$1,230.27	$1,230.27
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $38.90 / $57.54	Facility	26	$33.11	$38.90	$57.54
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $223.87 / $512.86	Professional		$125.89	$223.87	$512.86
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $57.54 / $158.49	Professional	26	$38.02	$57.54	$158.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $134.90 / $281.84	Professional	TC	$85.11	$134.90	$281.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $104.71	Professional		$32.36	$33.11	$104.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $41.69 / $131.83 / $467.74	Professional		$41.69	$131.83	$467.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.00 / $46.77 / $66.07	Facility	26	$10.00	$46.77	$66.07
Providence Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $213.80 / $389.05	Professional		$114.82	$213.80	$389.05
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $33.88 / $54.95 / $97.72	Professional	26	$33.88	$54.95	$97.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $147.91 / $288.40	Professional	TC	$77.62	$147.91	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $186.21 / $323.59	Professional		$120.23	$186.21	$323.59
United Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $45.71 / $83.18	Professional	26	$37.15	$45.71	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $128.82 / $234.42	Professional	TC	$83.18	$128.82	$234.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $123.03 / $154.88	Professional		$123.03	$123.03	$154.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $40.74 / $48.98	Professional	26	$38.90	$40.74	$48.98
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $83.18 / $104.71	Professional	TC	$83.18	$83.18	$104.71