Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $42.66 / $75.86	Facility	26	$33.11	$42.66	$75.86
Aetna Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $208.93 / $426.58	Professional		$151.36	$208.93	$426.58
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $37.15 / $50.12 / $112.20	Professional	26	$37.15	$50.12	$112.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $117.49 / $151.36 / $239.88	Professional	TC	$117.49	$151.36	$239.88
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $269.15 / $269.15 / $269.15	Professional		$269.15	$269.15	$269.15
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $48.98 / $85.11	Professional	26	$38.90	$48.98	$85.11
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $295.12 / $295.12 / $295.12	Professional	TC	$295.12	$295.12	$295.12
BCBS Facility/Professional Professional Modifier Low / Median / High Price $40.74 / $158.49 / $218.78	Professional		$40.74	$158.49	$218.78
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $204.17 / $229.09	Professional		$177.83	$204.17	$229.09
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $48.98 / $52.48	Professional	26	$48.98	$48.98	$52.48
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Cigna Facility/Professional Professional Modifier Low / Median / High Price $173.78 / $269.15 / $549.54	Professional		$173.78	$269.15	$549.54
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $60.26 / $120.23	Professional	26	$39.81	$60.26	$120.23
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $190.55 / $380.19	Professional	TC	$128.82	$190.55	$380.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $331.13 / $331.13 / $331.13	Facility	26	$331.13	$331.13	$331.13
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,380.38 / $1,698.24 / $1,698.24	Professional		$1,380.38	$1,698.24	$1,698.24
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $331.13 / $416.87 / $416.87	Professional	26	$331.13	$416.87	$416.87
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,047.13 / $1,288.25 / $1,288.25	Professional	TC	$1,047.13	$1,288.25	$1,288.25
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $33.11 / $38.02 / $75.86	Facility	26	$33.11	$38.02	$75.86
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $257.04 / $602.56	Professional		$162.18	$257.04	$602.56
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $39.81 / $56.23 / $123.03	Professional	26	$39.81	$56.23	$123.03
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $120.23 / $177.83 / $346.74	Professional	TC	$120.23	$177.83	$346.74
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $165.96	Professional		$32.36	$33.11	$165.96
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $52.48 / $181.97 / $389.05	Professional		$52.48	$181.97	$389.05
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $12.59 / $58.88 / $85.11	Facility	26	$12.59	$58.88	$85.11
Providence Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $288.40 / $562.34	Professional		$177.83	$288.40	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $56.23 / $102.33	Professional	26	$43.65	$56.23	$102.33
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $128.82 / $177.83 / $323.59	Professional	TC	$128.82	$177.83	$323.59
United Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $234.42 / $426.58	Professional		$190.55	$234.42	$426.58
United Facility/Professional Professional Modifier 26 Low / Median / High Price $45.71 / $56.23 / $104.71	Professional	26	$45.71	$56.23	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $144.54 / $177.83 / $323.59	Professional	TC	$144.54	$177.83	$323.59
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $199.53 / $234.42	Professional		$190.55	$199.53	$234.42
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $51.29 / $61.66	Professional	26	$48.98	$51.29	$61.66
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $141.25 / $141.25 / $173.78	Professional	TC	$141.25	$141.25	$173.78