Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $30.20 / $54.95	Facility	26	$27.54	$30.20	$54.95
Aetna Facility/Professional Professional Modifier Low / Median / High Price $97.72 / $134.90 / $323.59	Professional		$97.72	$134.90	$323.59
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $45.71 / $107.15	Professional	26	$30.20	$45.71	$107.15
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $91.20 / $165.96	Professional	TC	$67.61	$91.20	$165.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $169.82 / $263.03	Professional		$128.82	$169.82	$263.03
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $41.69 / $77.62	Professional	26	$31.62	$41.69	$77.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $33.11 / $107.15 / $144.54	Professional		$33.11	$107.15	$144.54
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $158.49 / $251.19	Professional		$120.23	$158.49	$251.19
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $40.74 / $42.66	Professional	26	$39.81	$40.74	$42.66
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Cigna Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $141.25 / $275.42	Professional		$102.33	$141.25	$275.42
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $43.65 / $87.10	Professional	26	$29.51	$43.65	$87.10
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $100.00 / $199.53	Professional	TC	$70.79	$100.00	$199.53
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $269.15 / $269.15 / $269.15	Facility	26	$269.15	$269.15	$269.15
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $933.25 / $1,148.15 / $1,148.15	Professional		$933.25	$1,148.15	$1,148.15
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $269.15 / $338.84 / $338.84	Professional	26	$269.15	$338.84	$338.84
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $660.69 / $794.33 / $794.33	Professional	TC	$660.69	$794.33	$794.33
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $27.54 / $34.67 / $54.95	Facility	26	$27.54	$34.67	$54.95
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $158.49 / $338.84	Professional		$107.15	$158.49	$338.84
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $30.90 / $51.29 / $104.71	Professional	26	$30.90	$51.29	$104.71
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $104.71 / $218.78	Professional	TC	$75.86	$104.71	$218.78
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 $44.67 / $138.04 / $295.12	Professional		$44.67	$138.04	$295.12
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $10.23 / $47.86 / $69.18	Facility	26	$10.23	$47.86	$69.18
Providence Facility/Professional Professional Modifier Low / Median / High Price $102.33 / $141.25 / $309.03	Professional		$102.33	$141.25	$309.03
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $28.84 / $42.66 / $74.13	Professional	26	$28.84	$42.66	$74.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $70.79 / $91.20 / $177.83	Professional	TC	$70.79	$91.20	$177.83
United Facility/Professional Professional Modifier Low / Median / High Price $107.15 / $131.83 / $208.93	Professional		$107.15	$131.83	$208.93
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $41.69 / $66.07	Professional	26	$31.62	$41.69	$66.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $75.86 / $91.20 / $147.91	Professional	TC	$75.86	$91.20	$147.91
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $134.90 / $162.18	Professional		$128.82	$134.90	$162.18
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $42.66 / $51.29	Professional	26	$40.74	$42.66	$51.29
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $93.33 / $109.65	Professional	TC	$87.10	$93.33	$109.65