Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $91.20 / $120.23	Facility	26	$57.54	$91.20	$120.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $398.11 / $1,047.13	Professional		$194.98	$398.11	$1,047.13
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $112.20 / $275.42	Professional	26	$66.07	$112.20	$275.42
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $138.04 / $512.86 / $562.34	Professional	52	$138.04	$512.86	$562.34
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $204.17 / $501.19	Professional	TC	$112.20	$204.17	$501.19
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $158.49 / $316.23	Professional		$123.03	$158.49	$316.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $66.07 / $123.03	Professional	26	$52.48	$66.07	$123.03
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $100.00 / $199.53	Professional	TC	$81.28	$100.00	$199.53
BCBS Facility/Professional Professional Modifier Low / Median / High Price $57.54 / $151.36 / $213.80	Professional		$57.54	$151.36	$213.80
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $281.84 / $691.83	Professional		$181.97	$281.84	$691.83
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $102.33 / $102.33	Professional	26	$66.07	$102.33	$102.33
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $371.54 / $724.44	Professional		$173.78	$371.54	$724.44
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $91.20 / $169.82	Professional	26	$58.88	$91.20	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $263.03 / $575.44	Professional	TC	$114.82	$263.03	$575.44
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $645.65 / $645.65 / $645.65	Facility	26	$645.65	$645.65	$645.65
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $234.42 / $3,019.95 / $3,019.95	Professional		$234.42	$3,019.95	$3,019.95
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $562.34 / $562.34 / $562.34	Professional	26	$562.34	$562.34	$562.34
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,570.40 / $2,570.40 / $2,570.40	Professional	TC	$2,570.40	$2,570.40	$2,570.40
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $75.86 / $120.23	Facility	26	$57.54	$75.86	$120.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $389.05 / $851.14	Professional		$194.98	$389.05	$851.14
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $67.61 / $114.82 / $257.04	Professional	26	$67.61	$114.82	$257.04
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $134.90 / $316.23 / $549.54	Professional	52	$134.90	$316.23	$549.54
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $218.78 / $489.78	Professional	TC	$123.03	$218.78	$489.78
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $158.49	Professional		$32.36	$33.11	$158.49
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $181.97 / $537.03	Professional		$70.79	$181.97	$537.03
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $114.82	Facility	26	$16.98	$79.43	$114.82
Providence Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $371.54 / $707.95	Professional		$177.83	$371.54	$707.95
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $89.13 / $151.36	Professional	26	$58.88	$89.13	$151.36
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $263.03 / $562.34	Professional	TC	$112.20	$263.03	$562.34
United Facility/Professional Professional Modifier Low / Median / High Price $186.21 / $288.40 / $562.34	Professional		$186.21	$288.40	$562.34
United Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $75.86 / $141.25	Professional	26	$63.10	$75.86	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $181.97 / $398.11	Professional	TC	$123.03	$181.97	$398.11
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $181.97 / $181.97 / $229.09	Professional		$181.97	$181.97	$229.09
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $69.18 / $83.18	Professional	26	$66.07	$69.18	$83.18
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $117.49 / $144.54	Professional	TC	$117.49	$117.49	$144.54