Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $48.98 / $67.61	Facility	26	$40.74	$48.98	$67.61
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $181.97 / $512.86	Professional		$125.89	$181.97	$512.86
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $60.26 / $173.78	Professional	26	$41.69	$60.26	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $120.23 / $281.84	Professional	TC	$79.43	$120.23	$281.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $79.43 / $112.20 / $128.82	Professional		$79.43	$112.20	$128.82
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $34.67 / $45.71 / $79.43	Professional	26	$34.67	$45.71	$79.43
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $77.62 / $109.65	Professional	TC	$77.62	$77.62	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $38.02 / $102.33 / $141.25	Professional		$38.02	$102.33	$141.25
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $181.97 / $245.47	Professional		$123.03	$181.97	$245.47
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $95.50 / $95.50	Professional	26	$43.65	$95.50	$95.50
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $213.80 / $436.52	Professional		$120.23	$213.80	$436.52
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $61.66 / $114.82	Professional	26	$39.81	$61.66	$114.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $154.88 / $323.59	Professional	TC	$79.43	$154.88	$323.59
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $426.58 / $426.58 / $426.58	Facility	26	$426.58	$426.58	$426.58
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $1,659.59 / $1,659.59	Professional		$162.18	$1,659.59	$1,659.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Professional	26	$380.19	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,348.96	Professional	TC	$1,348.96	$1,348.96	$1,348.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $40.74 / $47.86 / $67.61	Facility	26	$40.74	$47.86	$67.61
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $223.87 / $501.19	Professional		$131.83	$223.87	$501.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $63.10 / $151.36	Professional	26	$43.65	$63.10	$151.36
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $128.82 / $295.12	Professional	TC	$83.18	$128.82	$295.12
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $107.15	Professional		$32.36	$33.11	$107.15
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $125.89 / $363.08	Professional		$48.98	$125.89	$363.08
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $218.78 / $416.87	Professional		$123.03	$218.78	$416.87
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $57.54 / $97.72	Professional	26	$39.81	$57.54	$97.72
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $147.91 / $309.03	Professional	TC	$79.43	$147.91	$309.03
United Facility/Professional Professional Modifier Low / Median / High Price $134.90 / $194.98 / $363.08	Professional		$134.90	$194.98	$363.08
United Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $51.29 / $93.33	Professional	26	$41.69	$51.29	$93.33
United Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $138.04 / $263.03	Professional	TC	$91.20	$138.04	$263.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $154.88	Professional		$125.89	$125.89	$154.88
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $47.86 / $56.23	Professional	26	$45.71	$47.86	$56.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $79.43 / $100.00	Professional	TC	$79.43	$79.43	$100.00