Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $57.54 / $72.44	Facility	26	$46.77	$57.54	$72.44
Aetna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $190.55 / $549.54	Professional		$128.82	$190.55	$549.54
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $70.79 / $181.97	Professional	26	$51.29	$70.79	$181.97
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $114.82 / $257.04	Professional	TC	$75.86	$114.82	$257.04
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $85.11 / $109.65 / $229.09	Professional		$85.11	$109.65	$229.09
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $41.69 / $52.48 / $89.13	Professional	26	$41.69	$52.48	$89.13
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $102.33 / $107.15 / $120.23	Professional	TC	$102.33	$107.15	$120.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $43.65 / $107.15 / $165.96	Professional		$43.65	$107.15	$165.96
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $173.78 / $218.78	Professional		$128.82	$173.78	$218.78
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $53.70 / $56.23	Professional	26	$52.48	$53.70	$56.23
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $208.93 / $426.58	Professional		$120.23	$208.93	$426.58
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $66.07 / $131.83	Professional	26	$46.77	$66.07	$131.83
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $147.91 / $288.40	Professional	TC	$72.44	$147.91	$288.40
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $512.86 / $512.86 / $512.86	Facility	26	$512.86	$512.86	$512.86
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,621.81 / $1,621.81 / $1,621.81	Professional		$1,621.81	$1,621.81	$1,621.81
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $389.05 / $446.68 / $446.68	Professional	26	$389.05	$446.68	$446.68
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,659.59 / $1,659.59 / $1,659.59	Professional	TC	$1,659.59	$1,659.59	$1,659.59
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $46.77 / $56.23 / $75.86	Facility	26	$46.77	$56.23	$75.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $537.03	Professional		$138.04	$234.42	$537.03
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $51.29 / $75.86 / $165.96	Professional	26	$51.29	$75.86	$165.96
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $123.03 / $281.84	Professional	TC	$79.43	$123.03	$281.84
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $112.20	Professional		$32.36	$33.11	$112.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $56.23 / $131.83 / $380.19	Professional		$56.23	$131.83	$380.19
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $13.80 / $64.57 / $91.20	Facility	26	$13.80	$64.57	$91.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $208.93 / $407.38	Professional		$123.03	$208.93	$407.38
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $63.10 / $109.65	Professional	26	$46.77	$63.10	$109.65
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $147.91 / $281.84	Professional	TC	$72.44	$147.91	$281.84
United Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $186.21 / $338.84	Professional		$128.82	$186.21	$338.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $61.66 / $107.15	Professional	26	$48.98	$61.66	$107.15
United Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $112.20 / $223.87	Professional	TC	$77.62	$112.20	$223.87
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $138.04 / $162.18	Professional		$131.83	$138.04	$162.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $56.23 / $67.61	Professional	26	$53.70	$56.23	$67.61
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $77.62 / $77.62 / $97.72	Professional	TC	$77.62	$77.62	$97.72