Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $54.95 / $74.13	Facility	26	$47.86	$54.95	$74.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $229.09 / $501.19	Professional		$165.96	$229.09	$501.19
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $204.17	Professional	26	$51.29	$70.79	$204.17
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $147.91 / $302.00	Professional	TC	$109.65	$147.91	$302.00
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $60.26 / $107.15	Professional	26	$43.65	$60.26	$107.15
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $131.83 / $186.21	Professional		$47.86	$131.83	$186.21
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $165.96 / $245.47 / $380.19	Professional		$165.96	$245.47	$380.19
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $54.95 / $58.88	Professional	26	$53.70	$54.95	$58.88
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Cigna Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $263.03 / $524.81	Professional		$158.49	$263.03	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $70.79 / $131.83	Professional	26	$48.98	$70.79	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $190.55 / $398.11	Professional	TC	$107.15	$190.55	$398.11
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $524.81 / $524.81 / $524.81	Facility	26	$524.81	$524.81	$524.81
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional		$1,949.84	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $467.74 / $467.74	Professional	26	$436.52	$467.74	$467.74
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,949.84 / $1,949.84 / $1,949.84	Professional	TC	$1,949.84	$1,949.84	$1,949.84
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $54.95 / $89.13	Facility	26	$47.86	$54.95	$89.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $281.84 / $602.56	Professional		$169.82	$281.84	$602.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $75.86 / $186.21	Professional	26	$52.48	$75.86	$186.21
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $173.78 / $398.11	Professional	TC	$114.82	$173.78	$398.11
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $141.25	Professional		$32.36	$33.11	$141.25
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $58.88 / $158.49 / $436.52	Professional		$58.88	$158.49	$436.52
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.13 / $66.07 / $93.33	Facility	26	$14.13	$66.07	$93.33
Providence Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $263.03 / $501.19	Professional		$162.18	$263.03	$501.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $69.18 / $112.20	Professional	26	$48.98	$69.18	$112.20
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $181.97 / $389.05	Professional	TC	$104.71	$181.97	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $245.47 / $446.68	Professional		$173.78	$245.47	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $63.10 / $109.65	Professional	26	$50.12	$63.10	$109.65
United Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $177.83 / $331.13	Professional	TC	$117.49	$177.83	$331.13
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $162.18 / $204.17	Professional		$162.18	$162.18	$204.17
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $57.54 / $69.18	Professional	26	$54.95	$57.54	$69.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $107.15 / $134.90	Professional	TC	$107.15	$107.15	$134.90