Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $48.98 / $60.26 / $75.86	Facility	26	$48.98	$60.26	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $263.03 / $588.84	Professional		$173.78	$263.03	$588.84
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $186.21	Professional	26	$51.29	$72.44	$186.21
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $125.89 / $181.97 / $380.19	Professional	TC	$125.89	$181.97	$380.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $165.96 / $194.98	Professional		$79.43	$165.96	$194.98
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $56.23 / $109.65	Professional	26	$44.67	$56.23	$109.65
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $173.78 / $204.17	Professional	TC	$102.33	$173.78	$204.17
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $154.88 / $208.93	Professional		$47.86	$154.88	$208.93
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $251.19 / $371.54	Professional		$186.21	$251.19	$371.54
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $186.21 / $186.21	Professional	26	$54.95	$186.21	$186.21
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Cigna Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $302.00 / $630.96	Professional		$186.21	$302.00	$630.96
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $154.88	Professional	26	$50.12	$75.86	$154.88
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $223.87 / $478.63	Professional	TC	$131.83	$223.87	$478.63
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Facility	26	$537.03	$537.03	$537.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $2,398.83 / $2,398.83 / $2,398.83	Professional		$2,398.83	$2,398.83	$2,398.83
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $537.03 / $537.03 / $537.03	Professional	26	$537.03	$537.03	$537.03
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 $48.98 / $56.23 / $91.20	Facility	26	$48.98	$56.23	$91.20
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $302.00 / $645.65	Professional		$181.97	$302.00	$645.65
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $77.62 / $181.97	Professional	26	$52.48	$77.62	$181.97
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $208.93 / $436.52	Professional	TC	$128.82	$208.93	$436.52
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $162.18	Professional		$32.36	$33.11	$162.18
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $60.26 / $186.21 / $537.03	Professional		$60.26	$186.21	$537.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.45 / $67.61 / $95.50	Facility	26	$14.45	$67.61	$95.50
Providence Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $309.03 / $588.84	Professional		$186.21	$309.03	$588.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $75.86 / $125.89	Professional	26	$50.12	$75.86	$125.89
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $218.78 / $478.63	Professional	TC	$128.82	$218.78	$478.63
United Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $295.12 / $524.81	Professional		$199.53	$295.12	$524.81
United Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $70.79 / $123.03	Professional	26	$56.23	$70.79	$123.03
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $213.80 / $389.05	Professional	TC	$141.25	$213.80	$389.05
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $186.21 / $234.42	Professional		$186.21	$186.21	$234.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $58.88 / $70.79	Professional	26	$56.23	$58.88	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $131.83 / $162.18	Professional	TC	$131.83	$131.83	$162.18