Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $39.81 / $70.79	Facility	26	$32.36	$39.81	$70.79
Aetna Facility/Professional Professional Modifier Low / Median / High Price $104.71 / $141.25 / $257.04	Professional		$104.71	$141.25	$257.04
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $50.12 / $120.23	Professional	26	$33.11	$50.12	$120.23
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $97.72 / $165.96	Professional	TC	$72.44	$97.72	$165.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $295.12 / $295.12 / $295.12	Professional		$295.12	$295.12	$295.12
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $45.71 / $91.20	Professional	26	$37.15	$45.71	$91.20
BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $112.20 / $162.18	Professional		$40.74	$112.20	$162.18
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $162.18 / $234.42	Professional		$125.89	$162.18	$234.42
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $46.77 / $50.12	Professional	26	$45.71	$46.77	$50.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $54.95 / $79.43	Facility	26	$12.02	$54.95	$79.43
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.82 / $162.18 / $309.03	Professional		$114.82	$162.18	$309.03
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $30.20 / $47.86 / $95.50	Professional	26	$30.20	$47.86	$95.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $81.28 / $114.82 / $239.88	Professional	TC	$81.28	$114.82	$239.88
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $309.03 / $309.03 / $309.03	Facility	26	$309.03	$309.03	$309.03
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,023.29 / $1,258.93 / $1,258.93	Professional		$1,023.29	$1,258.93	$1,258.93
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $309.03 / $389.05 / $389.05	Professional	26	$309.03	$389.05	$389.05
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $707.95 / $870.96 / $870.96	Professional	TC	$707.95	$870.96	$870.96
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $32.36 / $37.15 / $63.10	Facility	26	$32.36	$37.15	$63.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $173.78 / $363.08	Professional		$117.49	$173.78	$363.08
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $33.11 / $57.54 / $117.49	Professional	26	$33.11	$57.54	$117.49
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $79.43 / $117.49 / $239.88	Professional	TC	$79.43	$117.49	$239.88
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $123.03	Professional		$32.36	$33.11	$123.03
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $154.88 / $346.74	Professional		$50.12	$154.88	$346.74
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.02 / $54.95 / $79.43	Facility	26	$12.02	$54.95	$79.43
Providence Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $158.49 / $346.74	Professional		$117.49	$158.49	$346.74
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $29.51 / $45.71 / $79.43	Professional	26	$29.51	$45.71	$79.43
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $83.18 / $107.15 / $208.93	Professional	TC	$83.18	$107.15	$208.93
United Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $147.91 / $245.47	Professional		$123.03	$147.91	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.62 / $44.67 / $74.13	Professional	26	$31.62	$44.67	$74.13
United Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $109.65 / $177.83	Professional	TC	$87.10	$109.65	$177.83
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $141.25 / $147.91 / $177.83	Professional		$141.25	$147.91	$177.83
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $46.77 / $48.98 / $58.88	Professional	26	$46.77	$48.98	$58.88
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $95.50 / $100.00 / $120.23	Professional	TC	$95.50	$100.00	$120.23