Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $38.90 / $42.66 / $79.43	Facility	26	$38.90	$42.66	$79.43
Aetna Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $181.97 / $1,230.27	Professional		$93.33	$181.97	$1,230.27
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $117.49 / $776.25	Professional	26	$48.98	$117.49	$776.25
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $46.77 / $72.44 / $165.96	Professional	TC	$46.77	$72.44	$165.96
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $93.33 / $128.82 / $190.55	Professional		$93.33	$128.82	$190.55
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $48.98 / $60.26 / $81.28	Professional	26	$48.98	$60.26	$81.28
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $67.61 / $67.61 / $67.61	Professional	TC	$67.61	$67.61	$67.61
BCBS Facility/Professional Professional Modifier Low / Median / High Price $47.86 / $100.00 / $162.18	Professional		$47.86	$100.00	$162.18
Baylor Scott & White Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $147.91 / $229.09	Professional		$117.49	$147.91	$229.09
Christus Facility/Professional Professional Modifier 26 Low / Median / High Price $57.54 / $61.66 / $61.66	Professional	26	$57.54	$61.66	$61.66
Cigna Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $169.82 / $288.40	Professional		$112.20	$169.82	$288.40
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $123.03	Professional	26	$52.48	$72.44	$123.03
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $58.88 / $93.33 / $165.96	Professional	TC	$58.88	$93.33	$165.96
Lucent Health Facility/Professional Facility Modifier 26 Low / Median / High Price $380.19 / $380.19 / $380.19	Facility	26	$380.19	$380.19	$380.19
Lucent Health Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional		$1,071.52	$1,071.52	$1,071.52
Lucent Health Facility/Professional Professional Modifier 26 Low / Median / High Price $724.44 / $724.44 / $851.14	Professional	26	$724.44	$724.44	$851.14
Lucent Health Facility/Professional Professional Modifier TC Low / Median / High Price $741.31 / $741.31 / $741.31	Professional	TC	$741.31	$741.31	$741.31
Moda Health Facility/Professional Facility Modifier 26 Low / Median / High Price $39.81 / $42.66 / $79.43	Facility	26	$39.81	$42.66	$79.43
Moda Health Facility/Professional Professional Modifier Low / Median / High Price $91.20 / $199.53 / $794.33	Professional		$91.20	$199.53	$794.33
Moda Health Facility/Professional Professional Modifier 26 Low / Median / High Price $47.86 / $100.00 / $660.69	Professional	26	$47.86	$100.00	$660.69
Moda Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.71 / $95.50 / $181.97	Professional	TC	$45.71	$95.50	$181.97
Molina Facility/Professional Professional Modifier Low / Median / High Price $32.36 / $33.11 / $104.71	Professional		$32.36	$33.11	$104.71
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $190.55 / $229.09 / $295.12	Professional		$190.55	$229.09	$295.12
Providence Facility/Professional Professional Modifier Low / Median / High Price $112.20 / $162.18 / $281.84	Professional		$112.20	$162.18	$281.84
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $52.48 / $72.44 / $117.49	Professional	26	$52.48	$72.44	$117.49
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $56.23 / $91.20 / $165.96	Professional	TC	$56.23	$91.20	$165.96
United Facility/Professional Professional Modifier Low / Median / High Price $117.49 / $177.83 / $245.47	Professional		$117.49	$177.83	$245.47
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.70 / $74.13 / $104.71	Professional	26	$53.70	$74.13	$104.71
United Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $95.50 / $144.54	Professional	TC	$63.10	$95.50	$144.54
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $120.23 / $120.23 / $125.89	Professional		$120.23	$120.23	$125.89
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $58.88 / $58.88 / $60.26	Professional	26	$58.88	$58.88	$60.26
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $63.10 / $63.10 / $66.07	Professional	TC	$63.10	$63.10	$66.07