Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $70.79 / $89.13	Facility	26	$57.54	$70.79	$89.13
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $169.82 / $389.05	Professional		$123.03	$169.82	$389.05
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $79.43 / $213.80	Professional	26	$54.95	$79.43	$213.80
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $87.10 / $234.42	Professional	TC	$63.10	$87.10	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $83.18 / $83.18 / $95.50	Professional		$83.18	$83.18	$95.50
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $128.82	Professional	26	$52.48	$72.44	$128.82
BCBS Facility/Professional Professional Modifier Low / Median / High Price $53.70 / $97.72 / $147.91	Professional		$53.70	$97.72	$147.91
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $165.96 / $229.09	Professional		$123.03	$165.96	$229.09
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $64.57 / $66.07 / $69.18	Professional	26	$64.57	$66.07	$69.18
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $177.83 / $398.11	Professional		$109.65	$177.83	$398.11
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $69.18 / $141.25	Professional	26	$48.98	$69.18	$141.25
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $53.70 / $89.13 / $269.15	Professional	TC	$53.70	$89.13	$269.15
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $630.96 / $630.96 / $630.96	Facility	26	$630.96	$630.96	$630.96
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,445.44 / $1,445.44 / $1,445.44	Professional		$1,445.44	$1,445.44	$1,445.44
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $436.52 / $549.54 / $549.54	Professional	26	$436.52	$549.54	$549.54
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,174.90 / $1,174.90 / $1,174.90	Professional	TC	$1,174.90	$1,174.90	$1,174.90
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $57.54 / $70.79 / $89.13	Facility	26	$57.54	$70.79	$89.13
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $186.21 / $436.52	Professional		$131.83	$186.21	$436.52
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $85.11 / $213.80	Professional	26	$56.23	$85.11	$213.80
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $64.57 / $95.50 / $229.09	Professional	TC	$64.57	$95.50	$229.09
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $54.95 / $112.20	Professional		$32.36	$54.95	$112.20
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $169.82 / $251.19 / $426.58	Professional		$169.82	$251.19	$426.58
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $16.98 / $79.43 / $112.20	Facility	26	$16.98	$79.43	$112.20
Providence Facility/Professional Professional Modifier Low / Median / High Price $109.65 / $181.97 / $380.19	Professional		$109.65	$181.97	$380.19
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $67.61 / $120.23	Professional	26	$47.86	$67.61	$120.23
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $85.11 / $245.47	Professional	TC	$52.48	$85.11	$245.47
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $154.88 / $309.03	Professional		$117.49	$154.88	$309.03
United Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $67.61 / $114.82	Professional	26	$47.86	$67.61	$114.82
United Facility/Professional Professional Modifier TC Low / Median / High Price $61.66 / $85.11 / $186.21	Professional	TC	$61.66	$85.11	$186.21
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $123.03 / $147.91	Professional		$117.49	$123.03	$147.91
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $69.18 / $81.28	Professional	26	$66.07	$69.18	$81.28
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $52.48 / $54.95 / $66.07	Professional	TC	$52.48	$54.95	$66.07