Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $38.90 / $63.10	Facility	26	$30.20	$38.90	$63.10
Aetna Facility/Professional Professional Modifier Low / Median / High Price $123.03 / $177.83 / $616.60	Professional		$123.03	$177.83	$616.60
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $53.70 / $131.83	Professional	26	$38.90	$53.70	$131.83
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $30.20	Professional	52	$30.20	$30.20	$30.20
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $85.11 / $117.49 / $234.42	Professional	TC	$85.11	$117.49	$234.42
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $128.82 / $257.04	Professional		$112.20	$128.82	$257.04
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $35.48 / $45.71 / $81.28	Professional	26	$35.48	$45.71	$81.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $72.44 / $91.20 / $109.65	Professional	TC	$72.44	$91.20	$109.65
BCBS Facility/Professional Professional Modifier Low / Median / High Price $36.31 / $123.03 / $165.96	Professional		$36.31	$123.03	$165.96
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $131.83 / $190.55 / $295.12	Professional		$131.83	$190.55	$295.12
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $43.65 / $50.12 / $50.12	Professional	26	$43.65	$50.12	$50.12
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Cigna Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $181.97 / $338.84	Professional		$128.82	$181.97	$338.84
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $53.70 / $104.71	Professional	26	$38.90	$53.70	$104.71
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $91.20 / $131.83 / $251.19	Professional	TC	$91.20	$131.83	$251.19
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $302.00 / $302.00 / $302.00	Facility	26	$302.00	$302.00	$302.00
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $1,023.29 / $1,318.26	Professional		$190.55	$1,023.29	$1,318.26
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $302.00 / $380.19 / $380.19	Professional	26	$302.00	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $724.44 / $954.99 / $954.99	Professional	TC	$724.44	$954.99	$954.99
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $30.20 / $38.90 / $60.26	Facility	26	$30.20	$38.90	$60.26
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $125.89 / $190.55 / $457.09	Professional		$125.89	$190.55	$457.09
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $38.02 / $54.95 / $134.90	Professional	26	$38.02	$54.95	$134.90
Moda Health Facility/Professional Professional Modifier 52 Low / Median / High Price $30.20 / $30.20 / $239.88	Professional	52	$30.20	$30.20	$239.88
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $87.10 / $128.82 / $257.04	Professional	TC	$87.10	$128.82	$257.04
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $125.89	Professional		$32.36	$33.11	$125.89
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $48.98 / $123.03 / $288.40	Professional		$48.98	$123.03	$288.40
Providence Facility/Professional Facility Modifier 26 Low / Median / High Price $11.48 / $53.70 / $75.86	Facility	26	$11.48	$53.70	$75.86
Providence Facility/Professional Professional Modifier Low / Median / High Price $128.82 / $177.83 / $371.54	Professional		$128.82	$177.83	$371.54
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $38.90 / $51.29 / $89.13	Professional	26	$38.90	$51.29	$89.13
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $89.13 / $120.23 / $213.80	Professional	TC	$89.13	$120.23	$213.80
United Facility/Professional Professional Modifier Low / Median / High Price $138.04 / $186.21 / $281.84	Professional		$138.04	$186.21	$281.84
United Facility/Professional Professional Modifier 26 Low / Median / High Price $40.74 / $54.95 / $83.18	Professional	26	$40.74	$54.95	$83.18
United Facility/Professional Professional Modifier TC Low / Median / High Price $97.72 / $131.83 / $199.53	Professional	TC	$97.72	$131.83	$199.53
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.36 / $158.49 / $186.21	Professional		$151.36	$158.49	$186.21
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $47.86 / $56.23	Professional	26	$47.86	$47.86	$56.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $104.71 / $109.65 / $131.83	Professional	TC	$104.71	$109.65	$131.83