Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $42.66 / $52.48 / $66.07	Facility	26	$42.66	$52.48	$66.07
Aetna Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $181.97 / $537.03	Professional		$125.89	$181.97	$537.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $61.66 / $169.82	Professional	26	$47.86	$61.66	$169.82
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $114.82 / $257.04	Professional	TC	$77.62	$114.82	$257.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $100.00 / $117.49 / $173.78	Professional		$100.00	$117.49	$173.78
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $51.29 / $95.50	Professional	26	$38.02	$51.29	$95.50
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $93.33 / $93.33 / $120.23	Professional	TC	$93.33	$93.33	$120.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $39.81 / $104.71 / $147.91	Professional		$39.81	$104.71	$147.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $323.59	Professional		$131.83	$190.55	$323.59
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $48.98 / $52.48	Professional	26	$47.86	$48.98	$52.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $83.18	Facility	26	$12.59	$58.88	$83.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $208.93 / $426.58	Professional		$117.49	$208.93	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $63.10 / $120.23	Professional	26	$42.66	$63.10	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $74.13 / $147.91 / $295.12	Professional	TC	$74.13	$147.91	$295.12
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $467.74 / $467.74 / $467.74	Facility	26	$467.74	$467.74	$467.74
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Professional		$1,659.59	$1,659.59	$1,659.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $323.59 / $407.38 / $407.38	Professional	26	$323.59	$407.38	$407.38
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 $42.66 / $51.29 / $66.07	Facility	26	$42.66	$51.29	$66.07
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $218.78 / $501.19	Professional		$131.83	$218.78	$501.19
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $66.07 / $162.18	Professional	26	$48.98	$66.07	$162.18
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $123.03 / $288.40	Professional	TC	$79.43	$123.03	$288.40
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $109.65	Professional		$32.36	$33.11	$109.65
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $125.89 / $323.59	Professional		$52.48	$125.89	$323.59
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $83.18	Facility	26	$12.59	$58.88	$83.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $208.93 / $398.11	Professional		$120.23	$208.93	$398.11
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $61.66 / $100.00	Professional	26	$42.66	$61.66	$100.00
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $147.91 / $288.40	Professional	TC	$72.44	$147.91	$288.40
United Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $181.97 / $338.84	Professional		$125.89	$181.97	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $54.95 / $97.72	Professional	26	$44.67	$54.95	$97.72
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $114.82 / $229.09	Professional	TC	$77.62	$114.82	$229.09
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $125.89 / $158.49	Professional		$125.89	$125.89	$158.49
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $51.29 / $60.26	Professional	26	$48.98	$51.29	$60.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $79.43 / $97.72	Professional	TC	$79.43	$79.43	$97.72