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 / $70.79	Facility	26	$45.71	$54.95	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $204.17 / $467.74	Professional		$117.49	$204.17	$467.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $72.44 / $208.93	Professional	26	$50.12	$72.44	$208.93
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $107.15 / $151.36 / $295.12	Professional	TC	$107.15	$151.36	$295.12
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $257.04 / $257.04 / $309.03	Professional		$257.04	$257.04	$309.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $52.48 / $102.33	Professional	26	$41.69	$52.48	$102.33
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $102.33 / $144.54	Professional	TC	$102.33	$102.33	$144.54
BCBS Facility/Professional Professional Modifier Low / Median / High Price $42.66 / $131.83 / $194.98	Professional		$42.66	$131.83	$194.98
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $199.53 / $309.03	Professional		$158.49	$199.53	$309.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $102.33 / $102.33	Professional	26	$51.29	$102.33	$102.33
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 $154.88 / $257.04 / $501.19	Professional		$154.88	$257.04	$501.19
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 $107.15 / $190.55 / $380.19	Professional	TC	$107.15	$190.55	$380.19
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 / $1,659.59 / $1,659.59	Professional		$1,659.59	$1,659.59	$1,659.59
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $380.19 / $436.52 / $436.52	Professional	26	$380.19	$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 $44.67 / $52.48 / $70.79	Facility	26	$44.67	$52.48	$70.79
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $263.03 / $537.03	Professional		$151.36	$263.03	$537.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $72.44 / $204.17	Professional	26	$51.29	$72.44	$204.17
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $112.20 / $173.78 / $380.19	Professional	TC	$112.20	$173.78	$380.19
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $138.04	Professional		$32.36	$33.11	$138.04
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $158.49 / $436.52	Professional		$56.23	$158.49	$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 $158.49 / $257.04 / $478.63	Professional		$158.49	$257.04	$478.63
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 $104.71 / $177.83 / $354.81	Professional	TC	$104.71	$177.83	$354.81
United Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $239.88 / $416.87	Professional		$169.82	$239.88	$416.87
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 $117.49 / $177.83 / $309.03	Professional	TC	$117.49	$177.83	$309.03
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $158.49 / $199.53	Professional		$158.49	$158.49	$199.53
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 $107.15 / $107.15 / $134.90	Professional	TC	$107.15	$107.15	$134.90