Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $53.70 / $70.79	Facility	26	$43.65	$53.70	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $213.80 / $524.81	Professional		$147.91	$213.80	$524.81
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $74.13 / $213.80	Professional	26	$51.29	$74.13	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $138.04 / $309.03	Professional	TC	$95.50	$138.04	$309.03
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $144.54 / $181.97	Professional		$134.90	$144.54	$181.97
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $51.29 / $97.72	Professional	26	$40.74	$51.29	$97.72
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $131.83 / $131.83	Professional	TC	$131.83	$131.83	$131.83
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $120.23 / $177.83	Professional		$43.65	$120.23	$177.83
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $213.80 / $288.40	Professional		$144.54	$213.80	$288.40
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $51.29 / $53.70	Professional	26	$50.12	$51.29	$53.70
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $60.26 / $87.10	Facility	26	$13.18	$60.26	$87.10
Cigna Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $251.19 / $501.19	Professional		$134.90	$251.19	$501.19
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $70.79 / $128.82	Professional	26	$44.67	$70.79	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $173.78 / $346.74	Professional	TC	$89.13	$173.78	$346.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $489.78 / $489.78 / $489.78	Facility	26	$489.78	$489.78	$489.78
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $1,698.24	Professional		$1,621.81	$1,621.81	$1,698.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $426.58 / $426.58	Professional	26	$389.05	$426.58	$426.58
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,041.74 / $2,041.74 / $2,041.74	Professional	TC	$2,041.74	$2,041.74	$2,041.74
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $43.65 / $53.70 / $70.79	Facility	26	$43.65	$53.70	$70.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $269.15 / $537.03	Professional		$154.88	$269.15	$537.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $181.97	Professional	26	$51.29	$75.86	$181.97
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $100.00 / $154.88 / $346.74	Professional	TC	$100.00	$154.88	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $125.89	Professional		$32.36	$33.11	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $54.95 / $158.49 / $575.44	Professional		$54.95	$158.49	$575.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.18 / $60.26 / $87.10	Facility	26	$13.18	$60.26	$87.10
Providence Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $257.04 / $457.09	Professional		$138.04	$257.04	$457.09
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $66.07 / $112.20	Professional	26	$44.67	$66.07	$112.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $165.96 / $346.74	Professional	TC	$89.13	$165.96	$346.74
United Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $218.78 / $389.05	Professional		$144.54	$218.78	$389.05
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $57.54 / $107.15	Professional	26	$48.98	$57.54	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $147.91 / $275.42	Professional	TC	$95.50	$147.91	$275.42
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $144.54 / $181.97	Professional		$144.54	$144.54	$181.97
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $53.70 / $63.10	Professional	26	$51.29	$53.70	$63.10
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $95.50 / $117.49	Professional	TC	$95.50	$95.50	$117.49