Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $72.44 / $79.43	Facility	26	$63.10	$72.44	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $281.84 / $707.95	Professional		$204.17	$281.84	$707.95
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $85.11 / $208.93	Professional	26	$60.26	$85.11	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $186.21 / $371.54	Professional	TC	$131.83	$186.21	$371.54
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.54 / $186.21 / $302.00	Professional		$144.54	$186.21	$302.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $79.43 / $141.25	Professional	26	$56.23	$79.43	$141.25
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $165.96 / $190.55	Professional	TC	$97.72	$165.96	$190.55
BCBS Facility/Professional Professional Modifier Low / Median / High Price $64.57 / $181.97 / $257.04	Professional		$64.57	$181.97	$257.04
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $263.03 / $416.87	Professional		$208.93	$263.03	$416.87
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $151.36 / $151.36	Professional	26	$70.79	$151.36	$151.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $316.23 / $630.96	Professional		$194.98	$316.23	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $83.18 / $165.96	Professional	26	$58.88	$83.18	$165.96
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $223.87 / $467.74	Professional	TC	$134.90	$223.87	$467.74
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $691.83 / $691.83 / $691.83	Facility	26	$691.83	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,995.26 / $1,995.26 / $2,041.74	Professional		$1,995.26	$1,995.26	$2,041.74
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $489.78 / $616.60 / $616.60	Professional	26	$489.78	$616.60	$616.60
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,995.26 / $1,995.26 / $1,995.26	Professional	TC	$1,995.26	$1,995.26	$1,995.26
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $72.44 / $79.43	Facility	26	$63.10	$72.44	$79.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $323.59 / $724.44	Professional		$208.93	$323.59	$724.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $93.33 / $194.98	Professional	26	$63.10	$93.33	$194.98
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $213.80 / $457.09	Professional	TC	$134.90	$213.80	$457.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $181.97	Professional		$32.36	$33.11	$181.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $77.62 / $229.09 / $660.69	Professional		$77.62	$229.09	$660.69
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $87.10 / $123.03	Facility	26	$18.62	$87.10	$123.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $316.23 / $602.56	Professional		$204.17	$316.23	$602.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $141.25	Professional	26	$58.88	$79.43	$141.25
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $218.78 / $436.52	Professional	TC	$131.83	$218.78	$436.52
United Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $295.12 / $512.86	Professional		$213.80	$295.12	$512.86
United Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $79.43 / $141.25	Professional	26	$58.88	$79.43	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $213.80 / $371.54	Professional	TC	$141.25	$213.80	$371.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $218.78 / $263.03	Professional		$208.93	$218.78	$263.03
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $72.44 / $75.86 / $91.20	Professional	26	$72.44	$75.86	$91.20
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $138.04 / $173.78	Professional	TC	$138.04	$138.04	$173.78