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 / $56.23	Facility	26	$45.71	$54.95	$56.23
Aetna Facility/Professional Professional Modifier Low / Median / High Price $154.88 / $239.88 / $489.78	Professional		$154.88	$239.88	$489.78
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $67.61 / $173.78	Professional	26	$48.98	$67.61	$173.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $186.21 / $323.59	Professional	TC	$131.83	$186.21	$323.59
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $173.78 / $398.11	Professional		$173.78	$173.78	$398.11
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $42.66 / $57.54 / $102.33	Professional	26	$42.66	$57.54	$102.33
BCBS Facility/Professional Professional Modifier Low / Median / High Price $45.71 / $158.49 / $234.42	Professional		$45.71	$158.49	$234.42
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $213.80 / $371.54	Professional		$177.83	$213.80	$371.54
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 $177.83 / $275.42 / $524.81	Professional		$177.83	$275.42	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $69.18 / $125.89	Professional	26	$45.71	$69.18	$125.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $204.17 / $416.87	Professional	TC	$131.83	$204.17	$416.87
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 $1,659.59 / $1,698.24 / $1,698.24	Professional		$1,659.59	$1,698.24	$1,698.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $346.74 / $436.52 / $436.52	Professional	26	$346.74	$436.52	$436.52
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,348.96 / $1,348.96 / $1,380.38	Professional	TC	$1,348.96	$1,348.96	$1,380.38
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $45.71 / $54.95 / $56.23	Facility	26	$45.71	$54.95	$56.23
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $281.84 / $588.84	Professional		$177.83	$281.84	$588.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $173.78	Professional	26	$51.29	$70.79	$173.78
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $138.04 / $208.93 / $416.87	Professional	TC	$138.04	$208.93	$416.87
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $165.96	Professional		$32.36	$33.11	$165.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $190.55 / $436.52	Professional		$56.23	$190.55	$436.52
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 $181.97 / $275.42 / $524.81	Professional		$181.97	$275.42	$524.81
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $64.57 / $107.15	Professional	26	$45.71	$64.57	$107.15
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $131.83 / $194.98 / $354.81	Professional	TC	$131.83	$194.98	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $257.04 / $446.68	Professional		$190.55	$257.04	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $58.88 / $104.71	Professional	26	$46.77	$58.88	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $194.98 / $338.84	Professional	TC	$141.25	$194.98	$338.84
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $190.55 / $239.88	Professional		$190.55	$190.55	$239.88
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 $138.04 / $138.04 / $173.78	Professional	TC	$138.04	$138.04	$173.78