Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $54.95 / $79.43	Facility	26	$45.71	$54.95	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $275.42 / $575.44	Professional		$199.53	$275.42	$575.44
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $194.98	Professional	26	$51.29	$70.79	$194.98
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $208.93 / $363.08	Professional	TC	$147.91	$208.93	$363.08
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $147.91 / $181.97 / $389.05	Professional		$147.91	$181.97	$389.05
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $52.48 / $100.00	Professional	26	$40.74	$52.48	$100.00
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $218.78 / $223.87 / $257.04	Professional	TC	$218.78	$223.87	$257.04
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $177.83 / $234.42	Professional		$42.66	$177.83	$234.42
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $302.00 / $446.68	Professional		$208.93	$302.00	$446.68
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $52.48 / $54.95	Professional	26	$51.29	$52.48	$54.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Cigna Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $288.40 / $549.54	Professional		$194.98	$288.40	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $69.18 / $128.82	Professional	26	$45.71	$69.18	$128.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $213.80 / $426.58	Professional	TC	$144.54	$213.80	$426.58
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $501.19 / $501.19 / $501.19	Facility	26	$501.19	$501.19	$501.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,862.09 / $1,949.84 / $1,949.84	Professional		$1,862.09	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $363.08 / $436.52 / $436.52	Professional	26	$363.08	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,584.89 / $1,584.89 / $1,584.89	Professional	TC	$1,584.89	$1,584.89	$1,584.89
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $44.67 / $54.95 / $79.43	Facility	26	$44.67	$54.95	$79.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $316.23 / $602.56	Professional		$208.93	$316.23	$602.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $177.83	Professional	26	$51.29	$72.44	$177.83
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $234.42 / $426.58	Professional	TC	$154.88	$234.42	$426.58
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $190.55	Professional		$32.36	$33.11	$190.55
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $213.80 / $457.09	Professional		$56.23	$213.80	$457.09
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.49 / $61.66 / $89.13	Facility	26	$13.49	$61.66	$89.13
Providence Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $288.40 / $562.34	Professional		$199.53	$288.40	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $66.07 / $107.15	Professional	26	$45.71	$66.07	$107.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $204.17 / $389.05	Professional	TC	$144.54	$204.17	$389.05
United Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $269.15 / $467.74	Professional		$204.17	$269.15	$467.74
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $58.88 / $104.71	Professional	26	$47.86	$58.88	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $208.93 / $363.08	Professional	TC	$154.88	$208.93	$363.08
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $213.80 / $213.80 / $269.15	Professional		$213.80	$213.80	$269.15
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $54.95 / $64.57	Professional	26	$52.48	$54.95	$64.57
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $204.17	Professional	TC	$162.18	$162.18	$204.17