Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $63.10 / $75.86 / $131.83	Facility	26	$63.10	$75.86	$131.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $165.96 / $309.03	Professional		$120.23	$165.96	$309.03
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $81.28 / $165.96	Professional	26	$57.54	$81.28	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $72.44 / $218.78	Professional	TC	$52.48	$72.44	$218.78
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $123.03 / $275.42	Professional		$117.49	$123.03	$275.42
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $69.18 / $95.50 / $120.23	Professional	26	$69.18	$95.50	$120.23
BCBS Facility/Professional Professional Modifier Low / Median / High Price $70.79 / $125.89 / $190.55	Professional		$70.79	$125.89	$190.55
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $218.78 / $263.03	Professional		$158.49	$218.78	$263.03
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $85.11 / $87.10 / $91.20	Professional	26	$85.11	$87.10	$91.20
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $104.71 / $151.36	Facility	26	$22.39	$104.71	$151.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $234.42 / $616.60	Professional		$138.04	$234.42	$616.60
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $91.20 / $181.97	Professional	26	$58.88	$91.20	$181.97
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $131.83 / $457.09	Professional	TC	$60.26	$131.83	$457.09
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $575.44 / $575.44 / $575.44	Facility	26	$575.44	$575.44	$575.44
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $3,235.94 / $3,235.94 / $3,235.94	Professional		$3,235.94	$3,235.94	$3,235.94
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $676.08 / $741.31 / $741.31	Professional	26	$676.08	$741.31	$741.31
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $2,884.03 / $2,884.03 / $2,884.03	Professional	TC	$2,884.03	$2,884.03	$2,884.03
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $64.57 / $131.83	Facility	26	$57.54	$64.57	$131.83
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $204.17 / $389.05	Professional		$125.89	$204.17	$389.05
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $60.26 / $93.33 / $190.55	Professional	26	$60.26	$93.33	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $91.20 / $245.47	Professional	TC	$53.70	$91.20	$245.47
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $131.83	Professional		$32.36	$33.11	$131.83
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $74.13 / $213.80 / $562.34	Professional		$74.13	$213.80	$562.34
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $22.39 / $104.71 / $151.36	Facility	26	$22.39	$104.71	$151.36
Providence Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $229.09 / $562.34	Professional		$138.04	$229.09	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $89.13 / $158.49	Professional	26	$56.23	$89.13	$158.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $60.26 / $120.23 / $416.87	Professional	TC	$60.26	$120.23	$416.87
United Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $208.93 / $446.68	Professional		$151.36	$208.93	$446.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $61.66 / $89.13 / $141.25	Professional	26	$61.66	$89.13	$141.25
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $117.49 / $346.74	Professional	TC	$69.18	$117.49	$346.74
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $158.49 / $165.96 / $194.98	Professional		$158.49	$165.96	$194.98
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $87.10 / $93.33 / $109.65	Professional	26	$87.10	$93.33	$109.65
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $69.18 / $72.44 / $85.11	Professional	TC	$69.18	$72.44	$85.11