Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $61.66 / $77.62	Facility	26	$50.12	$61.66	$77.62
Aetna Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $288.40 / $891.25	Professional		$208.93	$288.40	$891.25
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $81.28 / $218.78	Professional	26	$52.48	$81.28	$218.78
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $213.80 / $446.68	Professional	TC	$151.36	$213.80	$446.68
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $181.97 / $380.19	Professional		$151.36	$181.97	$380.19
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $44.67 / $58.88 / $112.20	Professional	26	$44.67	$58.88	$112.20
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $158.49 / $223.87	Professional	TC	$123.03	$158.49	$223.87
BCBS Facility/Professional Professional Modifier Low / Median / High Price $46.77 / $181.97 / $269.15	Professional		$46.77	$181.97	$269.15
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $229.09 / $295.12	Professional		$204.17	$229.09	$295.12
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $151.36 / $151.36	Professional	26	$56.23	$151.36	$151.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Cigna Facility/Professional Professional Modifier Low / Median / High Price $199.53 / $302.00 / $588.84	Professional		$199.53	$302.00	$588.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $141.25	Professional	26	$50.12	$70.79	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $223.87 / $446.68	Professional	TC	$144.54	$223.87	$446.68
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $549.54 / $549.54 / $549.54	Facility	26	$549.54	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,905.46 / $1,949.84 / $1,949.84	Professional		$1,905.46	$1,949.84	$1,949.84
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $446.68 / $478.63 / $478.63	Professional	26	$446.68	$478.63	$478.63
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,089.30 / $2,089.30 / $2,089.30	Professional	TC	$2,089.30	$2,089.30	$2,089.30
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $50.12 / $61.66 / $81.28	Facility	26	$50.12	$61.66	$81.28
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $323.59 / $691.83	Professional		$218.78	$323.59	$691.83
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $81.28 / $190.55	Professional	26	$54.95	$81.28	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $154.88 / $234.42 / $446.68	Professional	TC	$154.88	$234.42	$446.68
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 $60.26 / $218.78 / $575.44	Professional		$60.26	$218.78	$575.44
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $14.79 / $69.18 / $97.72	Facility	26	$14.79	$69.18	$97.72
Providence Facility/Professional Professional Modifier Low / Median / High Price $204.17 / $302.00 / $602.56	Professional		$204.17	$302.00	$602.56
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $50.12 / $70.79 / $117.49	Professional	26	$50.12	$70.79	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $213.80 / $407.38	Professional	TC	$144.54	$213.80	$407.38
United Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $288.40 / $489.78	Professional		$208.93	$288.40	$489.78
United Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $64.57 / $114.82	Professional	26	$52.48	$64.57	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $151.36 / $218.78 / $380.19	Professional	TC	$151.36	$218.78	$380.19
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $229.09 / $275.42	Professional		$218.78	$229.09	$275.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $58.88 / $70.79	Professional	26	$57.54	$58.88	$70.79
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $162.18 / $162.18 / $204.17	Professional	TC	$162.18	$162.18	$204.17