Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $54.95 / $63.10	Facility	26	$47.86	$54.95	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $162.18 / $234.42 / $645.65	Professional		$162.18	$234.42	$645.65
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $54.95 / $77.62 / $165.96	Professional	26	$54.95	$77.62	$165.96
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $151.36 / $338.84	Professional	TC	$109.65	$151.36	$338.84
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $239.88 / $239.88 / $371.54	Professional		$239.88	$239.88	$371.54
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $60.26 / $117.49	Professional	26	$57.54	$60.26	$117.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $109.65 / $109.65 / $109.65	Professional	TC	$109.65	$109.65	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $181.97 / $257.04	Professional		$75.86	$181.97	$257.04
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $245.47 / $338.84	Professional		$194.98	$245.47	$338.84
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $79.43 / $79.43	Professional	26	$70.79	$79.43	$79.43
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Cigna Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $295.12 / $524.81	Professional		$190.55	$295.12	$524.81
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $87.10 / $169.82	Professional	26	$57.54	$87.10	$169.82
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $181.97 / $371.54	Professional	TC	$123.03	$181.97	$371.54
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $691.83 / $691.83 / $691.83	Facility	26	$691.83	$691.83	$691.83
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,479.11 / $1,862.09 / $1,862.09	Professional		$1,479.11	$1,862.09	$1,862.09
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $478.63 / $602.56 / $602.56	Professional	26	$478.63	$602.56	$602.56
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $1,000.00 / $1,258.93 / $1,258.93	Professional	TC	$1,000.00	$1,258.93	$1,258.93
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $47.86 / $50.12 / $63.10	Facility	26	$47.86	$50.12	$63.10
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $177.83 / $338.84 / $724.44	Professional		$177.83	$338.84	$724.44
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.23 / $95.50 / $190.55	Professional	26	$56.23	$95.50	$190.55
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $114.82 / $181.97 / $371.54	Professional	TC	$114.82	$181.97	$371.54
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $181.97	Professional		$32.36	$33.11	$181.97
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $75.86 / $204.17 / $416.87	Professional		$75.86	$204.17	$416.87
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $18.62 / $85.11 / $123.03	Facility	26	$18.62	$85.11	$123.03
Providence Facility/Professional Professional Modifier Low / Median / High Price $194.98 / $316.23 / $562.34	Professional		$194.98	$316.23	$562.34
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $63.10 / $81.28 / $147.91	Professional	26	$63.10	$81.28	$147.91
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $123.03 / $169.82 / $316.23	Professional	TC	$123.03	$169.82	$316.23
United Facility/Professional Professional Modifier Low / Median / High Price $218.78 / $489.78 / $933.25	Professional		$218.78	$489.78	$933.25
United Facility/Professional Professional Modifier 26 Low / Median / High Price $66.07 / $81.28 / $151.36	Professional	26	$66.07	$81.28	$151.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $147.91 / $354.81 / $776.25	Professional	TC	$147.91	$354.81	$776.25
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $208.93 / $208.93 / $257.04	Professional		$208.93	$208.93	$257.04
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $70.79 / $74.13 / $89.13	Professional	26	$70.79	$74.13	$89.13
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $134.90 / $134.90 / $169.82	Professional	TC	$134.90	$134.90	$169.82